A 20% sugary drink tax would cut number of UK obese adults by 180,000

Thursday, October 31, 2013 - 10:46

A 20% tax on sugar sweetened drinks would reduce the number of UK adults who are obese by 180,000 (1.3%) and who are overweight by 285,000 (0.9%), suggests a study published on bmj.com today.

Although this is a relatively modest effect, people aged 16-29 years, as the major consumers of sugar sweetened drinks, would be impacted the most, say the authors.

Regular consumption of sugar sweetened drinks increases the risk of obesity, diabetes, and tooth decay. The idea of a sugar sweetened drink tax as one way to reduce consumption and raise revenue is gaining traction in the UK, but its effect on health remains uncertain.

So researchers at the universities of Oxford and Reading set out to estimate the effect of a 20% tax on sugar sweetened drinks on obesity in the UK and to understand the health effect on different income groups.

Using data from surveys of dietary purchases, the price of drinks, and body weight, they estimate that a 20% sales tax on sugar sweetened drinks would reduce the number of obese adults in the UK by 180,000 (1.3%) and the number who are overweight by 285,000 (0.9%).

The health gains would be similar across all income groups, but would decline with age. As the major consumers of sugar sweetened drinks, young people (under the age of 30 years) would experience the greatest reductions in obesity. The tax would be expected to raise 276m (326m; $442m) annually (around 8p per person p er week) and would reduce consumption of sugar sweetened drinks by around 15%. This revenue, say the authors, could be used to increase NHS funding during a period of budget restrictions or to subsidise foods with health benefits, such as fruit and vegetables. They conclude that taxation of sugar sweetened drinks is a promising population measure to target population obesity, particularly among younger adults. But they stress that it should not be seen as a panacea and say further work is needed to clarify the level (and patterns) of sugar sweetened drink consumption in the UK.

In an accompanying editorial, Jason Block, Assistant Professor at Harvard Medical School in the US, says this study provides evidence that a 20% tax on sugary drinks can work and he calls on more countries to implement high taxes and measure the results.

A proposal by the Academy of Medical Royal Colleges calling for the UK to pilot and monitor the effect of a one year 20% tax on sugary drinks would be a good start, he says. Econometric modelling studies are important and helpful but provide projections rather than measures after actual policy change. We now need policy makers to act and provide opportunities for real world evidence on a 20% tax on sugar sweetened drinks, he concludes.

Contacts: Research: Dr Adam Briggs, Joint-first author. Academic Clinical Fellow, British Heart Foundation Health Promotion Research Group, Nuffield Department of Population Health, University of Oxford, UK adam.briggs@dph.ox.ac.uk or Dr Peter Scarborough. Senior Researcher, British Heart Foundation Health Promotion Research Group, Nuffield Department of Population Health, University of Oxford, UK peter.scarborough@dph.ox.ac.uk Editorial: Jason Block, Assistant Professor, Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, MA, USA jblock1@partners.org

Taxing sugar-sweetened soft drinks at 20% would cut the number of obese adults in the United Kingdom by 180,000 (1.3%) and the numbers of overweight adults by 285,000 (0.9%), researchers report in a study published online October 31 in BMJ. No tax has yet been levied on sugary drinks in the United Kingdom, but momentum to do so is gaining, said Peter Scarborough, DPhil, senior researcher with the Nuffield Department of Population Health at the University of Oxford, United Kingdom, and one of the authors of the study. "Sugary drink taxes are moving up the political agenda in the UK," he told Medscape Medical News. "There are health-related [nongovernmental organizations] calling for their introduction, including Sustain, the Academy of Medical Royal Colleges and the UK Health Forum. The Liberal Democrats have debated their introduction at their national conference.... Increasingly, national governments are recognizing the health burden imposed by sugary drinks and that this burden could be reduced by measures to discourage consumption."

To calculate the effect of such a tax, Lead author Adam Briggs, MSc, an academic clinical fellow in public health from the British Heart Foundation Health Promotion Research Group, Nuffield Department of Population Health, University of Oxford, and colleagues used surveys of food and drink purchases, the price of drinks, and body weight. They estimated that a 20% tax would be expected to raise 276 million ($US442 million) a year, which is about 8 pence per person per week, and would reduce consumption of sugar-sweetened drinks by nearly 15%. If the tax rate were lowered to 10%, the authors estimate that the health benefit would drop by roughly half: 89,400 fewer obese people in the United Kingdom. Britons aged 16 to 29 years, the major consumers of sugar-sweetened drinks, would be affected most, the authors note. In an accompanying editorial, Jason Block, MD, assistant professor at Obesity Prevention Program, Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Health Care Institute, Boston, Massachusetts, said the UK researchers' work shows that a 20% tax on sugary drinks can work to curb obesity. He urges policymakers in other countries to implement the high tax as well. In the United States, some attempts to do so have already been shot down. Two California cities, Richmond and El Monte, both failed last year to become the first American cities to pass a penny-per-ounce tax on the drinks. New York City's Mayor Michael Bloomberg passed a ban on the sale of large sugary drinks, but the proposal was declared illegal by a state judge. The New York Supreme Court has agreed to hear an appeal. The fight is very much alive in other locales. For example, in San Francisco this week, two members of the board of supervisors on Tuesday proposed asking voters in November 2014 to impose a tax of 2 cents per ounce on drinks with added sugar and at least 25 calories per ounce. Mexico is also considering a tax. Its 32.8% obesity rate is the second-largest percentage among major countries (after Egypt), edging out the US rate of 31.8%, according to the 2013 State of Food and Agriculture Report. Mexico's lower house approved the soft drink tax of 1 peso (US$0.08) per liter and sent it on to the Senate for approval.

Reuters reported this afternoon that the Mexican Senate passed it as well, raising the odds that Mexico could lead the way in a global trend to tax sugary beverages. The average Mexican consumes 43 gallons of soft drinks a year compared with 31 gallons per person in the United States, according to the Rudd Center for Food Policy and Obesity at Yale University in New Haven, Connecticut. The authors and editorialist have disclosed no relevant financial relationships. BMJ. Published online October 31, 2013.

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February 1, 2012 Americans are eating unhealthy amounts of sugar, and excess sugar should be regulated like alcohol and tobacco, say researchers from the University of California, San Francisco. "We are now seeing the toxic downside [of excess sugar intake]," Robert H. Lustig, MD, a professor of clinical pediatrics at the UCSF Center for Obesity Assessment, Study, and Treatment, tells WebMD. "There has to be some sort of societal intervention. We cannot do it on our own because sugar is addictive. Personal intervention is necessary, but not sufficient." His views on regulating sugar are published as a commentary in the journal Nature. Regulating Sugar: Industry Weigh-In WebMD asked the Sugar Association, an industry group, to review the recommendations. Charles Baker, PhD, the association's chief scientific officer, responded by email. "When the full body of science is evaluated during a major review, experts continue to conclude that sugar intake is not a causative factor in any disease, including obesity," he says. Sugar and Its Effects in Excess Excess sugar in the diet does not just add calories, Lustig writes. Too much sugar has been linked with health problems, and they occur even in people who are normal weight, he says.

According to Lustig, too much sugar can be linked with some health problems including: High blood pressure (He says fructose raises uric acid, in turn raising blood pressure.)

Diabetes Increase in the blood fats called triglycerides Obesity Liver problems

Sugar has the potential for abuse, he tells WebMD. "Like tobacco and alcohol, " he writes, "it acts on the brain to encourage subsequent intake." A key point: Lustig is talking about added sugars, not those naturally occurring in such foods as fruit or milk. He defines added sugar as ''any sweetener containing the molecule fructose that is added to food in processing." Men should eat no more than nine teaspoons of added sugar a day, according to the American Heart Association. Women should eat no more than six teaspoons. A typical 12-ounce regular soda includes about eight teaspoons of sugar, according to the AHA. The average intake of added sugars in the U.S. is about 22 teaspoons a day. Regulating Sugar: Perspective "The commentary should be a wake-up call to policymakers," says Marion Nestle, PhD, MPH, the Paulette Goddard professor of nutrition, food studies, and public health at New York University. She reviewed the commentary for WebMD. "He has the science to back it up," she says of Lustig's suggestion that it is time to regulate sugar. "That Americans would be healthier consuming less sugars is obvious and easily demonstrated," Nestle tells WebMD. "Sugars themselves are not harmful if eaten with other nutrients, as in fruits, and in diets that balance calories. But it's hard to balance calories when eating a lot of sugars."

Some people eat so much sugar that it adds up to half their daily calorie limit for maintaining weight, Nestle tells WebMD. "At the very least, the FDA should require listing added sugars on package labels," Nestle says. A good first step for anyone trying to reduce sugar, Nestle says, is to cut back on or cut out sugary drinks. Sugar: How to Regulate? Models used to regulate alcohol and tobacco could work for sugar, Lustig says. His suggestions:

Tax sugary foods. (The soda tax is already being considered, he notes. To work, he says the tax must be hefty, such as a $1 tax on a $1 can of soda.)

Limit availability. Licensing requirements on vending machines could be stricter. Set an age limit for the purchase of sugary drinks and foods.

The FDA could help, he says, by removing fructose from its GRAS (Generally Recognized as Safe) list. This allows food makers to add it without premarket review and approval.