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

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  • Additional Information
    • Affiliation:
      Centre for Health Policy, Institute of Global Health Innovation, Imperial College London, London, United Kingdom
      Department of Public Health and Forensic Sciences and Medical Education, Faculty of Medicine, University of Porto, Porto, Portugal
      Epidemiology Research Unit, Institute of Public Health, University of Porto, Porto, Portugal
      Centre for Innovation, Technology and Policy Research, University of Lisbon, Lisbon, Portugal
      Directorate General of Health, Lisbon, Portugal
      Faculty of Nutrition and Food Sciences, University of Porto, Porto, Portugal
      Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, England
      Department of Psychological Sciences, University of Liverpool, Liverpool, United Kingdom
      Centre for Public Administration and Public Policies, Institute of Social and Political Sciences, University of Lisbon, Lisbon, Portugal
      Department of Economics and Public Policy, Imperial College Business School, London, United Kingdom
      Centre for Health Economics and Policy Innovation, Imperial College Business School, London, United Kingdom
      Department of Surgery and Cancer, Imperial College London, London, United Kingdom
      WHO Collaborating Centre for Nutrition and Childhood Obesity, National Institute of Health (INSA), Lisbon, Portugal
      WHO European Office for the Prevention and Control of Noncommunicable Diseases, WHO Regional Office for Europe, Moscow, Russian Federation
      University Hospital of São João, Faculty of Medicine, University of Porto, Porto, Portugal
    • 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.
    • Journal Subset:
      Biomedical; USA
    • ISSN:
      1549-1277
    • MEDLINE Info:
      PMID: NLM32163412 NLM UID: 101231360
    • Grant Information:
      /DH_/Department of Health/United Kingdom
    • Publication Date:
      In Process
    • Publication Date:
      20200620
    • DOI:
      10.1371/journal.pmed.1003036
    • Accession Number:
      142202855
  • Citations
    • ABNT:
      GOIANA-DA-SILVA, F. et al. Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study. PLoS Medicine, [s. l.], v. 17, n. 3, p. 1–17, 2020. DOI 10.1371/journal.pmed.1003036. Disponível em: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=142202855. Acesso em: 22 out. 2020.
    • AMA:
      Goiana-da-Silva F, Severo M, Cruz e Silva D, et al. Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study. PLoS Medicine. 2020;17(3):1-17. doi:10.1371/journal.pmed.1003036
    • APA:
      Goiana-da-Silva, F., Severo, M., Cruz e Silva, D., Gregório, M. J., Allen, L. N., Muc, M., Morais Nunes, A., Torres, D., Miraldo, M., Ashrafian, H., Rito, A., Wickramasinghe, K., Breda, J., Darzi, A., Araújo, F., & Lopes, C. (2020). Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study. PLoS Medicine, 17(3), 1–17. https://doi.org/10.1371/journal.pmed.1003036
    • Chicago/Turabian: Author-Date:
      Goiana-da-Silva, Francisco, Milton Severo, David Cruz e Silva, Maria João Gregório, Luke N. Allen, Magdalena Muc, Alexandre Morais Nunes, et al. 2020. “Projected Impact of the Portuguese Sugar-Sweetened Beverage Tax on Obesity Incidence across Different Age Groups: A Modelling Study.” PLoS Medicine 17 (3): 1–17. doi:10.1371/journal.pmed.1003036.
    • Harvard:
      Goiana-da-Silva, F. et al. (2020) ‘Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study’, PLoS Medicine, 17(3), pp. 1–17. doi: 10.1371/journal.pmed.1003036.
    • Harvard: Australian:
      Goiana-da-Silva, F, Severo, M, Cruz e Silva, D, Gregório, MJ, Allen, LN, Muc, M, Morais Nunes, A, Torres, D, Miraldo, M, Ashrafian, H, Rito, A, Wickramasinghe, K, Breda, J, Darzi, A, Araújo, F & Lopes, C 2020, ‘Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study’, PLoS Medicine, vol. 17, no. 3, pp. 1–17, viewed 22 October 2020, .
    • MLA:
      Goiana-da-Silva, Francisco, et al. “Projected Impact of the Portuguese Sugar-Sweetened Beverage Tax on Obesity Incidence across Different Age Groups: A Modelling Study.” PLoS Medicine, vol. 17, no. 3, Mar. 2020, pp. 1–17. EBSCOhost, doi:10.1371/journal.pmed.1003036.
    • Chicago/Turabian: Humanities:
      Goiana-da-Silva, Francisco, Milton Severo, David Cruz e Silva, Maria João Gregório, Luke N. Allen, Magdalena Muc, Alexandre Morais Nunes, et al. “Projected Impact of the Portuguese Sugar-Sweetened Beverage Tax on Obesity Incidence across Different Age Groups: A Modelling Study.” PLoS Medicine 17, no. 3 (March 12, 2020): 1–17. doi:10.1371/journal.pmed.1003036.
    • Vancouver/ICMJE:
      Goiana-da-Silva F, Severo M, Cruz e Silva D, Gregório MJ, Allen LN, Muc M, et al. Projected impact of the Portuguese sugar-sweetened beverage tax on obesity incidence across different age groups: A modelling study. PLoS Medicine [Internet]. 2020 Mar 12 [cited 2020 Oct 22];17(3):1–17. Available from: http://search.ebscohost.com/login.aspx?direct=true&site=eds-live&db=rzh&AN=142202855