Soft drink taxation, advertising and labelling laws significantly impact behaviour

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Laws affecting the labelling, marketing and taxation of sugary soft drinks impact the behaviour of both consumers and manufacturers, according to separate studies from Chile and the UK.

In the first study, Camila Corvalán of the University of Chile and colleagues analysed the impact of Chile’s Law of Food Labelling and Advertising, implemented in 2016. The law mandates front-of-packaging warning labels, restricts child-directed marketing and bans sales in schools of all foods and beverages containing added sugars, sodium or saturated fats over threshold levels.

The study used national data on packaged beverage purchases from 2,383 urban households in Chile between 2015 and 2017.

The researchers concluded that after the implementation of the new policies, the purchase of beverages high in sugar, sodium, saturated fat or calories decreased by 22.8 mL per capita per day (95% CI 22.7-22.9, p<0.001), or 23.7% (95% CI 23.7- 23.8). Calories from such beverages decreased by 11.9 kcal per capita per day (95% CI 11.9-12.0) or 27.5% (95% CI 27.5-27.6). While households with varied levels of education had similar absolute reductions in the consumption of these beverages, the relative reduction was greater in more highly educated households due to a lower consumption before the policies.

“Future research will be needed to understand to what degree these changes are attributable to product reformulation and/or to changes in consumer behavior as well as the impact of these regulations on dietary intake and health-related outcomes,” the researchers say.

In the second study, Peter Scarborough of University of Oxford, and colleagues looked at the effect of the UK Soft Drinks Industry Levy (SDIL). This levy, announced in March 2016 and implemented in April 2018, charges manufacturers and importers a levy on soft drinks of 18p per litre for drinks with between 5 grams and 8 grams of sugar per 100mL, and 24p per litre for drinks with greater than 8 grams of sugar per 100mL.

In the study, researchers used a total of 209,637 observations of soft drinks available from UK supermarket websites at 85 time points between September 2015 and February 2019. Over that time period, the proportion of drinks with more than 5 grams of sugar per 100mL fell by 33.8% (95%CI 33.3-34.4, p<0.001), from 49% to 15%.

There was little change in the product size or the number of products available to consumer and there were no similar reductions in the sugar level of drinks exempt from the SDIL such as fruit juice and milk-based drinks. The price of high sugar drinks increased by an average of £0.075 (95%CI £0.037-£0.115 p<0.001), or 31% of the cost of the levy.

“The SDIL incentivised many manufacturers to reduce sugar in soft drinks. Some of the SDIL was passed onto consumers as higher prices, but not always on targeted drinks,” the researchers say. The authors suggest the SDIL may have resulted in reformulation of sugar sweetened beverages and that these changes could reduce population exposure to liquid sugars and associated health risks.

Abstract
Background: Chile’s Law of Food Labeling and Advertising, implemented in 2016, was the first national regulation to jointly mandate front-of-package warning labels, restrict child-directed marketing, and ban sales in schools of all foods and beverages containing added sugars, sodium, or saturated fats that exceed set nutrient or calorie thresholds. The objective of this study is to evaluate the impact of this package of policies on household beverage purchases.

Method and findings: In this observational study, monthly longitudinal data on packaged beverage purchases were collected from urban-dwelling households (n = 2,383) participating in the Kantar WordPanel Chile Survey from January 1, 2015, to December 31, 2017. Beverage purchases were linked to nutritional information at the product level, reviewed by a team of nutritionists, and categorized as “high-in” or “not high-in” according to whether they contained high levels of nutrients of concern (i.e., sugars, sodium, saturated fat, or energy) according to Chilean nutrient thresholds and were thus subject to the law’s warning label, marketing restriction, and school sales ban policies. The majority of high-in beverages were categorized as such because of high sugar content. We used fixed-effects models to compare the observed volume as well as calorie and sugar content of postregulation beverage purchases to a counterfactual based on preregulation trends, overall and by household-head educational attainment. Of households included in the study, 37% of household heads had low education (less than high school), 40% had medium education (graduated high school), and 23% had high education (graduated college), with the sample becoming more educated over the study period. Compared to the counterfactual, the volume of high-in beverage purchases decreased 22.8 mL/capita/day, postregulation (95% confidence interval [CI] −22.9 to −22.7; p < 0.001), or 23.7% (95% CI −23.8% to −23.7%). High-educated and low-educated households showed similar absolute reductions in high-in beverage purchases (approximately 27 mL/capita/day; p < 0.001), but for high-educated households this amounted to a larger relative decline (−28.7%, 95% CI −28.8% to −28.6%) compared to low-educated households (−21.5%, 95% CI −21.6% to −21.4%), likely because of the high-educated households’ lower level of high-in beverage purchases in the pre-regulation period. Calories from high-in beverage purchases decreased 11.9 kcal/capita/day (95% CI −12.0 to −11.9; p < 0.001) or 27.5% (95% CI −27.6% to −27.5%). Calories purchased from beverages classified as “not high-in” increased 5.7 kcal/capita/day (95% CI 5.7–5.7; p < 0.001), or 10.8% (10.8%–10.8%). Calories from total beverage purchases decreased 7.4 kcal/capita/day (95% CI −7.4 to −7.3; p < 0.001), or 7.5% (95% CI −7.6% to −7.5%). A key limitation of this study is the inability to assess causality because of its observational nature. We also cannot determine whether observed changes in purchases are due to reformulation or consumer behavioral change, nor can we parse out the effects of the labeling, marketing, and school sales ban policies.
Conclusions: Purchases of high-in beverages significantly declined following implementation of Chile’s Law of Food Labeling and Advertising; these reductions were larger than those observed from single, standalone policies, including sugar-sweetened-beverage taxes previously implemented in Latin America. Future research should evaluate the effects of Chile’s policies on purchases of high-in foods, dietary intake, and long-term purchasing changes.

Authors
Taillie LS, Reyes M, Colchero MA, Popkin B, Corvalán C

Abstract 2
Background: Dietary sugar, especially in liquid form, increases risk of dental caries, adiposity, and type 2 diabetes. The United Kingdom Soft Drinks Industry Levy (SDIL) was announced in March 2016 and implemented in April 2018 and charges manufacturers and importers at £0.24 per litre for drinks with over 8 g sugar per 100 mL (high levy category), £0.18 per litre for drinks with 5 to 8 g sugar per 100 mL (low levy category), and no charge for drinks with less than 5 g sugar per 100 mL (no levy category). Fruit juices and milk-based drinks are exempt. We measured the impact of the SDIL on price, product size, number of soft drinks on the marketplace, and the proportion of drinks over the lower levy threshold of 5 g sugar per 100 mL.

Methods and findings: We analysed data on a total of 209,637 observations of soft drinks over 85 time points between September 2015 and February 2019, collected from the websites of the leading supermarkets in the UK. The data set was structured as a repeat cross-sectional study. We used controlled interrupted time series to assess the impact of the SDIL on changes in level and slope for the 4 outcome variables. Equivalent models were run for potentially levy-eligible drink categories (‘intervention’ drinks) and levy-exempt fruit juices and milk-based drinks (‘control’ drinks). Observed results were compared with counterfactual scenarios based on extrapolation of pre-SDIL trends. We found that in February 2019, the proportion of intervention drinks over the lower levy sugar threshold had fallen by 33.8 percentage points (95% CI: 33.3–34.4, p < 0.001). The price of intervention drinks in the high levy category had risen by £0.075 (£0.037–0.115, p < 0.001) per litre—a 31% pass through rate—whilst prices of intervention drinks in the low levy category and no levy category had fallen and risen by smaller amounts, respectively. Whilst the product size of branded high levy and low levy drinks barely changed after implementation of the SDIL (−7 mL [−23 to 11 mL] and 16 mL [6–27ml], respectively), there were large changes to product size of own-brand drinks with an increase of 172 mL (133–214 mL) for high levy drinks and a decrease of 141 mL (111–170 mL) for low levy drinks. The number of available drinks that were in the high levy category when the SDIL was announced was reduced by 3 (−6 to 12) by the implementation of the SDIL. Equivalent models for control drinks provided little evidence of impact of the SDIL. These results are not sales weighted, so do not give an account of how sugar consumption from drinks may have changed over the time period.
Conclusions: The results suggest that the SDIL incentivised many manufacturers to reduce sugar in soft drinks. Some of the cost of the levy to manufacturers and importers was passed on to consumers as higher prices but not always on targeted drinks. These changes could reduce population exposure to liquid sugars and associated health risks.

Authors
Peter Scarborough, Vyas Adhikari, Richard A Harrington, Ahmed Elhussein, Adam Briggs, Mike Rayner, Jean Adams, Steven Cummins, Tarra Penney, Martin White

PLOS Medicine abstract 1

PLOS Medicine abstract 2

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