tag:theconversation.com,2011:/us/topics/soda-tax-25921/articlesSoda tax – The Conversation2021-02-21T12:05:53Ztag:theconversation.com,2011:article/1551082021-02-21T12:05:53Z2021-02-21T12:05:53ZA sin tax on sugary drinks unfairly targets Indigenous communities instead of improving health<figure><img src="https://images.theconversation.com/files/385316/original/file-20210219-15-2hg8nd.jpg?ixlib=rb-1.1.0&rect=99%2C46%2C3941%2C3122&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A water bottle sits on the table in front of Chief and NDP candidate Rudy Turtle during a visit by NDP Leader Jagmeet Singh on Oct. 5, 2019 on the Grassy Narrows First Nation, where industrial mercury poisoning in its water system has seriously affected the health of the community.</span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Paul Chiasson</span></span></figcaption></figure><p>“Sin taxes” are a tried, <a href="https://knowledge.wharton.upenn.edu/article/do-sin-taxes-really-change-consumer-behavior/">although not necessarily true</a>, strategy for reducing harm connected to alcohol and tobacco. Calls for a tax on sugar-sweetened beverages are supported by a large body of evidence linking weight gain and Type 2 diabetes, to excess consumption of these drinks. <a href="https://apps.who.int/iris/bitstream/handle/10665/260253/WHO-NMH-PND-16.5Rev.1-eng.pdf?sequence=1&isAllowed=y">This response is supported by the World Health Organization</a>, among others, <a href="https://www.heartandstroke.ca/-/media/pdf-files/canada/media-centre/the-health-and-economic-impact-of-a-sugary-drink-tax-in-canada-summary.ashx">to offset negative health and economic effects</a>. </p>
<p>The <a href="https://greenparty.mb.ca/news/manitoba-greens-sugar-tax-proposal-would-save-36-million-in-health-care-costs/">idea of taxing sugar-sweetened beverages</a> has <a href="https://www.cbc.ca/news/politics/liberals-ontario-soda-tax-proposal-federal-election-campaign-katie-simpson-1.5136724">caught the attention of political leaders</a> <a href="https://www.fin.gov.nt.ca/en/services/have-your-say-proposed-nwt-sugar-sweetened-drinks-tax">in Canada</a>, too. However, this paternalistic “we know best” approach ignores the most obvious needs and rights of Indigenous Peoples. Rather than seeing the harms of colonization to Indigenous Peoples, governments are fixating on how to tax the Coke in their hands. </p>
<p>Imposing a sugary beverage tax on Indigenous consumers would <a href="https://www.economist.com/the-economist-explains/2018/08/10/do-sin-taxes-work">be unethical</a>, contravene tax law and undermine Indigenous rights to self-determination. Even the <a href="https://www.cbc.ca/news/canada/manitoba/indigenous-forced-labour-sugar-beet-farms-1.4165272">production of sugar in Canada</a> has exploited Indigenous people, who were used essentially as forced labour. </p>
<h2>Health and mental health gaps</h2>
<p>The connection between lack of employment, education and family supports, to poorer health outcomes <a href="https://www.wellesleyinstitute.com/wp-content/uploads/2015/02/Full-Report-FPSCT-Updated.pdf">is well documented</a>. For Indigenous peoples, who often occupy the worst end of wellness measures, this is directly connected to the legacy of colonization. </p>
<p>Moreover, the health gap is profound and getting worse. <a href="http://mchp-appserv.cpe.umanitoba.ca/reference/FN_Report_web.pdf">The Manitoba Centre for Health Policy</a> found the life expectancy gap between First Nations persons and all other Manitobans has widened to 11 years from eight years since 2002. </p>
<p>It comes as no surprise then that Indigenous Peoples also experience diabetes at much higher rates. In Canada, treating diabetes <a href="https://www.diabetes.ca/media-room/press-releases/new-data-shows-diabetes-rates-and-economic-burden-on-families-continue-to-rise-in-ontario--">costs upwards of $30 billion per year</a>. It seems unlikely that a tax on sugary drinks can set this crisis right.</p>
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<span class="caption">Laura Green, a resident of Shoal Lake 40 First Nation, was photographed while speaking about water and access issues in her community on Feb. 25, 2015. The boil water advisory at Shoal Lake 40 has lasted more than two decades, beginning in 1997.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/John Woods</span></span>
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<p>Similarly, for those struggling with addiction, eating disorders or other challenges, adding more tax provides no support for better “lifestyle choices.” There is <a href="https://doi.org/10.1016/j.ypmed.2021.106447">evidence linking adverse childhood experiences</a> and trauma to higher intake of sugar-sweetened beverages both in childhood and later in life, as well as <a href="http://doi.org/10.3390/nu12051485">calls to include sugar-sweetened drinks within addiction models</a>, including for survivors of <a href="https://doi.org/10.1016/j.ypmed.2020.106176">childhood maltreatment</a> who disproportionately use food to cope.</p>
<p>Indigenous Peoples are also more likely to live with <a href="https://www.fnha.ca/what-we-do/mental-wellness-and-substance-use">mental illness and addiction</a>, largely due to <a href="http://www.nccah-ccnsa.ca/Publications/Lists/Publications/Attachments/142/2015-04-28-AguiarHalseth-RPT-IntergenTraumaHistory-EN-Web.pdf">intergenerational trauma</a>. This raises ethical questions about taxing addiction or behaviours associated with trauma, particularly in light of its colonial roots.</p>
<h2>Taxes, food and water</h2>
<p>One obvious problem with taxing sugar-sweetened beverage consumption by First Nations persons is their <a href="https://www.canada.ca/en/revenue-agency/services/aboriginal-peoples/indians.html">tax-exempt status</a> for all purchases made on reserves. There is no Canadian tax scheme that can avoid this exemption, thus a tax on sugary beverages has no impact on those who are at highest risk for Type 2 diabetes. With the growing presence of <a href="https://www.ictinc.ca/blog/what-are-urban-reserves">urban reserves</a> in many Canadian cities, buying tax-exempt sugar-sweetened beverages is increasingly easy. </p>
<p>Taxation also doesn’t address <a href="https://theconversation.com/canadas-food-guide-is-easy-to-follow-if-youre-wealthy-or-middle-class-114963">underlying issues of food insecurity</a>, prevalent in communities with high Indigenous populations. In urban areas, the <a href="https://doi.org/10.1186/s12937-019-0488-5">2015 Canadian Community Health Survey</a> found Indigenous populations to have the highest intake of sugar-sweetened beverages of any racial or ethnic group. This often reflects a <a href="https://doi.org/10.3390/ijerph17238818">lack of healthy and affordable food in neighbourhoods</a> with large Indigenous populations.</p>
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Read more:
<a href="https://theconversation.com/mining-push-continues-despite-water-crisis-in-neskantaga-first-nation-and-ontarios-ring-of-fire-150522">Mining push continues despite water crisis in Neskantaga First Nation and Ontario’s Ring of Fire</a>
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<p>Canada’s historic approach to resource development and wildlife management has been to ignore the needs and rights of Indigenous communities. Industry was allowed to pollute water bodies, <a href="https://pulitzercenter.org/projects/generations-activism-grassy-narrows-first-nations-fight-clean-water">including with mercury</a>, and destroy food sources relied upon by Indigenous Peoples. For <a href="https://doi.org/10.1503/cmaj.181617">northern</a>, <a href="http://www.fnfnes.ca/docs/FNFNES_draft_technical_report_Nov_2__2019.pdf">rural, remote</a> and <a href="https://proof.utoronto.ca/wp-content/uploads/2020/03/Household-Food-Insecurity-in-Canada-2017-2018-Full-Reportpdf.pdf">urban populations</a>, food insecurity continues to be a problem. Increasing food prices wouldn’t fix this.</p>
<p>A tax on sugar-sweetened beverages implies that Indigenous Peoples can either make better food choices, or choose to pay the tax. Yet <a href="https://canadians.org/fn-water">safe drinking water</a> and <a href="https://www.rcinet.ca/eye-on-the-arctic/2019/03/29/canada-nutrition-north-food-security-iqaluit-grocery-price/">affordable food</a> are not within reach of many Indigenous Peoples. </p>
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<a href="https://theconversation.com/water-crisis-in-first-nations-communities-runs-deeper-than-long-term-drinking-water-advisories-148977">Water crisis in First Nations communities runs deeper than long-term drinking water advisories</a>
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<p>The disconnect here is how taxing sugary drinks will help reduce diabetes and other health problems for this group. There is a serious credibility gap when governments demand consumers pay extra when choices are limited, and then promise tax revenue will be used to benefit their health. Despite promises by the federal government to fix all boil water advisories in five years, <a href="https://globalnews.ca/news/7497223/indigenous-services-minister-says-trudeau-government-wont-end-boil-water-advisories-by-march-2021/">it failed to deliver</a> on this basic human right. </p>
<h2>Shifting responsibility</h2>
<p>The solution, it seems, shifts responsibility for wellness from addressing inequality, to imposing a sugar-sweetened beverage tax on those most affected by poverty and lack of clean water, and for whom <a href="https://theconversation.com/joyce-echaquans-death-how-a-decolonizing-approach-could-help-tackle-racism-in-health-care-148517">racism in health care</a> is a daily reality. By framing the “problem” just the right way, the “solution” is easy to sell to a nation struggling to accept responsibility for the continuing harms of colonization.</p>
<p>As a young nation, Canada signed Treaty agreements to share land and resources. Instead of honouring those promises, Canada enacted the <a href="https://indigenousfoundations.arts.ubc.ca/the_indian_act/"><em>Indian Act</em></a>, essentially stripping First Nations of even the most basic human rights. Since then, Canadian governments have rarely acted in the best interests of Indigenous Peoples. </p>
<p>Today, Canada is considering <a href="https://parl.ca/DocumentViewer/en/43-2/bill/C-15/first-reading">Bill C-15</a> to adopt minimum standards of Indigenous rights as set out in the <a href="https://www.un.org/development/desa/indigenouspeoples/wp-content/uploads/sites/19/2018/11/UNDRIP_E_web.pdf">United Nations Declaration on the Rights of Indigenous Peoples</a>. This includes the right to self determination. Rather than taxing sugar-sweetened beverages, a better solution is to end paternalism and to provide real choices by confronting inequality and racism.</p><img src="https://counter.theconversation.com/content/155108/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Myra J Tait receives funding from Canadian Institutes of Health Research.</span></em></p><p class="fine-print"><em><span>Natalie Diane Riediger receives funding from Canadian Institutes of Health Research. </span></em></p>A tax on sugar-sweetened beverages may be intended to improve health, but for Indigenous consumers, such a tax would be unethical, contravene tax law and undermine Indigenous rights.Myra J Tait, Assistant Professor, Governance, Law and Management, Athabasca UniversityNatalie Diane Riediger, Assistant Professor of Nutritional Epidemiology, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1423452020-07-17T13:32:54Z2020-07-17T13:32:54ZPoorest Americans drink a lot more sugary drinks than the richest – which is why soda taxes could help reduce gaping health inequalities<figure><img src="https://images.theconversation.com/files/348142/original/file-20200717-37-tjdn6g.jpg?ixlib=rb-1.1.0&rect=219%2C78%2C5628%2C3410&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Soda contributes to obesity and other diseases. </span> </figcaption></figure><p>Many countries such as the <a href="https://www.lshtm.ac.uk/research/research-action/features/uk-sugar-tax-will-it-work">U.K.</a> and <a href="https://www.latimes.com/science/sciencenow/la-sci-sn-soda-tax-mexico-20161102-story.html">Mexico</a> and a handful of U.S. cities such as <a href="https://drexel.edu/now/archive/2020/February/Soda-Tax-and-Beverage-Consumption/">Philadelphia</a> and <a href="https://sftreasurer.org/business/taxes-fees/sugary-drinks-tax">San Francisco</a> have imposed soda taxes in an effort to fight rising obesity. </p>
<p>Lots of research shows a link between drinking sugary substances and a <a href="https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html#:%7E:text=Frequently%20drinking%20sugar%2Dsweetened%20beverages,gout%2C%20a%20type%20of%20arthritis">whole host of negative health outcomes</a>, including type 2 diabetes, heart disease, liver disease, tooth decay and gout. </p>
<p>As economists who study <a href="https://www.researchgate.net/profile/Jay_Zagorsky">economic status</a> and <a href="http://www-personal.umd.umich.edu/%7Epksmith/research.htm">health</a>, we wanted to look at this from another perspective: Does how wealthy you are affect how much soda you consume? And could reducing sugary beverage consumption narrow the <a href="https://www.nationalacademies.org/news/2017/01/new-report-identifies-root-causes-of-health-inequity-in-the-us-outlines-solutions-for-communities-to-advance-health-equity">double-digit life expectancy gap</a> between the richest and poorest Americans? </p>
<h2>Wealth and soda</h2>
<p><a href="https://www.doi.org/10.1016/j.ehb.2020.100888">We analyzed data</a> for over 24,000 U.S. adults in two nationally representative random samples from the <a href="http://www.nlsinfo.org/">National Longitudinal Surveys</a>, which follow groups of people over a period of time, asking them hundreds of questions each year on a variety of topics like employment, health and attitudes. Some questions are asked every year, while others are included less frequently. </p>
<p>We looked at two groups of people. The first is referred to as the <a href="https://www.nlsinfo.org/content/cohorts/nlsy79">NLS 1979 cohort</a> and includes people born from 1957 to 1964. They were asked how often they consumed sugary drinks in the previous week every other year from 2008 to 2016, meaning the respondents were in their 40s and 50s when asked the question. </p>
<p>The second group is known as the <a href="https://www.nlsinfo.org/content/cohorts/nlsy97">NLS 1997 cohort</a> and includes people born from 1980 to 1984. They were asked the sugary drink question four times from 2009 to 2015, putting them in their 20s and 30s. </p>
<p><a href="https://www.cdc.gov/nchs/products/databriefs/db122.htm">Prior studies</a> <a href="http://www.doi.org/10.3945/ajcn.111.018366">have found</a> that consumption of sugary drinks <a href="http://www.doi.org/10.1016/j.jand.2012.09.016">tend to rise</a> as income falls. But few of them controlled for the range of other factors that could also matter, such as gender, race and ethnicity, education, cognitive skills and interest in health and nutrition. Moreover, none of them focused on wealth, which can offer unique insights on the issue. </p>
<p>Wealth represents an accumulation of resources rather than a regular flow of income. Newly graduated doctors have high income and low wealth, while retirees may have high wealth, but little income. The difference between income and wealth means they could affect consumption patterns differently. Wealth is distributed much more unequally. In addition, individuals may signal their membership in the upper economic echelons through the foods they consume.</p>
<p>[<em><a href="https://theconversation.com/us/newsletters/the-daily-3?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=experts">Expertise in your inbox. Sign up for The Conversation’s newsletter and get expert takes on today’s news, every day.</a></em>]</p>
<p>We first looked at the share of respondents who reported drinking any sugar-sweetened beverages in the survey week by income and wealth deciles, which divides them into 10 equal groups depending on their income or wealth. </p>
<p>The number of sugar-sweetened beverages consumed generally falls as income rises. We found the same pattern when we looked at wealth, but the differences by wealth are more pronounced. Our analysis suggests that adults living in the richest 10% of families drink about 2.5 fewer sugary drinks a week than those in the poorest 10%. </p>
<p>This decline in sugary drink consumption as income and wealth rise holds up even after taking into account things like education, race, gender, cognitive abilities and interest in nutrition. </p>
<p>What’s the impact of 2.5 more sugar drinks a week? Rough calculations based on the typical sugar amounts in these drinks – <a href="https://sphhp.buffalo.edu/content/dam/sphhp/emergency-responder-human-performance/understanding-nutrition-labels.pdf">about 9.5 teaspoons</a> per 12-ounce can – suggest that it could result in <a href="https://www.livestrong.com/article/532975-how-to-calculate-how-many-calories-comes-from-sugar/">about 5.6 pounds of weight gain</a> over a year, assuming no increase in physical activity or decrease in consumption of calories from other sources.</p>
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<h2>For richer or poorer</h2>
<p>We also wondered whether soda consumption might change as people gain or lose wealth or make more or less money. Would increases in economic status correlate with decreases in sugary drink consumption?</p>
<p>Over the four-year periods we could observe, changes in income and wealth, even large ones, were not correlated to changes in sugary drink intake. We did not observe that adults who had gotten richer tended to report a drop in the number of sugary drinks consumed.</p>
<p>One possible explanation is that while economic status shapes our early drinking habits, those habits don’t much change in adulthood. Another possible explanation is that four years is not enough time for noticeable changes in sugar-sweetened beverage consumption to happen.</p>
<p>Our finding that people who are wealthier or make more money consume fewer sugary drinks supports the idea that soda consumption contributes to <a href="https://www.nationalacademies.org/news/2017/01/new-report-identifies-root-causes-of-health-inequity-in-the-us-outlines-solutions-for-communities-to-advance-health-equity">health inequities</a> along the economic distribution.</p>
<p>However, that doesn’t mean soda taxes are the best way to reduce these inequities. Since we find that sugary beverage consumption is higher for poorer Americans, these taxes can be regressive – meaning they fall more heavily on those with less income. On the other hand, if people with lower incomes respond to the higher prices caused by “soda taxes” by cutting consumption substantially, they can avoid the tax and improve their health. </p>
<p>A <a href="http://doi.org/10.1161/CIRCULATIONAHA.119.042956">just-published study</a> suggests that some soda taxes may be more effective than others at changing drinking habits. Specifically, it found that taxes based on the quantity of sugar in a drink are more successful than those simply based on volume, which <a href="https://www.cnn.com/2020/06/22/health/soda-tax-sugar-content-wellness/index.html">are more common in the U.S.</a></p>
<p>So well-designed soda taxes can help reduce rich-poor health disparities, but we’ll need a range of strategies to achieve that goal.</p><img src="https://counter.theconversation.com/content/142345/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>But the taxes have to be well-designed to avoid being overly regressive and targeting the poor.Patricia Smith, Professor of Economics, University of MichiganJay L. Zagorsky, Senior Lecturer, Questrom School of Business, Boston UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1293172020-01-27T12:20:03Z2020-01-27T12:20:03ZObesity, second to smoking as the most preventable cause of US deaths, needs new approaches<figure><img src="https://images.theconversation.com/files/310518/original/file-20200116-181593-akwlnw.jpg?ixlib=rb-1.1.0&rect=26%2C13%2C4394%2C3148&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Social campaigns to address the obesity crisis in America are failing. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/diet-change-healthy-lifestyle-concept-having-277748333">Lightspring/Shutterstock.com</a></span></figcaption></figure><p>The opioid crisis and deaths related to e-cigarette use among teenagers have dominated news headlines recently. Recently, the Centers for Disease Control and Prevention reported that 34 people had died as a result of vaping and, in 2017, opioid addiction was responsible <a href="https://www.cdc.gov/drugoverdose/data/statedeaths.html">for more than 47,000 deaths</a> in the U.S. Opioid addiction has been declared a <a href="https://www.cms.gov/About-CMS/Agency-Information/Emergency/EPRO/Current-Emergencies/Ongoing-emergencies">public health emergency</a>. </p>
<p>Yet these serious public health threats obscure an ever-present and growing calamity of obesity in the United States. Obesity is second only to cigarette smoking as a <a href="https://www.commonwealthfund.org/blog/2018/rising-obesity-united-states-public-health-crisis">leading preventable death</a> in the U.S. Nearly <a href="https://www.mailman.columbia.edu/public-health-now/news/obesity-kills-more-americans-previously-thought">one in five deaths of African Americans and Caucasians age 40 to 85</a> is attributed to obesity, a rate that is increasing across generations. </p>
<p>Clearly society needs better strategies to address this public health emergency. As a <a href="https://scholar.google.com/citations?user=E3XmWfEAAAAJ&hl=en">health economist</a> who has spent decades studying ways to prevent disease, I believe there are some policy options that could help.</p>
<h2>The American obesity crisis</h2>
<p><a href="https://www.cdc.gov/obesity/adult/causes.html">Many factors contribute to obesity</a>, including genetics, diet, physical inactivity, medications, lack of education and food marketing. </p>
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<img alt="" src="https://images.theconversation.com/files/311485/original/file-20200123-32164-3zl0lr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/311485/original/file-20200123-32164-3zl0lr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/311485/original/file-20200123-32164-3zl0lr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/311485/original/file-20200123-32164-3zl0lr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/311485/original/file-20200123-32164-3zl0lr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=545&fit=crop&dpr=1 754w, https://images.theconversation.com/files/311485/original/file-20200123-32164-3zl0lr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=545&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/311485/original/file-20200123-32164-3zl0lr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=545&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The volume of food consumed contributes to weight gain.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Go-For-the-Food-Cincinnati/ef8097858c154e5aa856fc9b36059d8a/13/0">Al Behrman/APimages.com</a></span>
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<p>People who are obese face heightened risk for diabetes, heart disease, stroke, high blood pressure and certain types of cancers, among other conditions. The estimated annual medical cost of obesity in the United States is <a href="https://www.cdc.gov/obesity/data/adult.html">$147 billion</a>, with most of those costs hitting public programs such as Medicare and Medicaid. Similar trends have been <a href="https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight">observed internationally among developed countries</a>.</p>
<p>So what can we do about it? The massive public and private efforts to control smoking provide both a template for addressing obesity and a benchmark for social impact. Tactics such as education, cigarette taxes, and smoke-free public spaces resulted in a 66% decline in smoking between 1965 and 2018, when cigarette smoking reached <a href="https://www.cdc.gov/media/releases/2019/p1114-smoking-low.html">an all-time low</a> of 13.7% among U.S. adults.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/311487/original/file-20200123-32170-1y2r7ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/311487/original/file-20200123-32170-1y2r7ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/311487/original/file-20200123-32170-1y2r7ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=396&fit=crop&dpr=1 600w, https://images.theconversation.com/files/311487/original/file-20200123-32170-1y2r7ra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=396&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/311487/original/file-20200123-32170-1y2r7ra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=396&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/311487/original/file-20200123-32170-1y2r7ra.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=498&fit=crop&dpr=1 754w, https://images.theconversation.com/files/311487/original/file-20200123-32170-1y2r7ra.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=498&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/311487/original/file-20200123-32170-1y2r7ra.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=498&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Cigarette smoking has plummeted in the U.S.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Cancer-Deaths-Decline/b99a642bd8a0426b985f6878b6083cb7/166/0">Jenny Kane/apimages.com</a></span>
</figcaption>
</figure>
<p>This outcome is associated with major health <a href="https://www.ncbi.nlm.nih.gov/books/NBK53017/">improvements</a> – reduced cardiovascular disease, stroke, various cancers and mortality from lung cancer. Medicaid alone saves an estimated $2.5 billion a year from <a href="https://doi.org/10.1001/jamanetworkopen.2019.2307">smoking-related health improvements</a>.</p>
<p>From a public investment perspective, the potential bang for the buck is even <a href="https://doi.org/10.2307/41791016">bigger for obesity than it is for tobacco</a>. In my view, a successful anti-obesity campaign must encourage people to be less sedentary; invest in new medical treatments and nutrition science; and create regulatory and health insurance policies that reward behavioral change. It also means <a href="https://onlinelibrary.wiley.com/doi/full/10.1002/oby.22696">broader access to effective therapies</a>.</p>
<h2>Good ideas that aren’t working</h2>
<p>Our current emphasis on behavioral interventions has been disappointing. Society needs to find a way to talk about obesity and come up with ways to deal with it that do not involve <a href="https://labblog.uofmhealth.org/body-work/fat-shaming-wont-solve-obesity-science-might">body-shaming</a> Losing weight means eating less or exercising more, or both, but there are no guarantees with either approach. Getting people to exercise is difficult. <a href="https://health.gov/paguidelines/second-edition/pdf/Physical_Activity_Guidelines_2nd_edition.pdf">Nearly 80%</a> of adults are not meeting the key guidelines for both aerobic and muscle-strengthening activity. </p>
<p>Getting people to change their diet is similarly ineffective. <a href="http://newsroom.ucla.edu/releases/Dieting-Does-Not-Work-UCLA-Researchers-7832">According to one study</a>, half of dieters had gained 11 pounds five years after starting their diet; some progress but hardly enough. Similarly, nutritional labels <a href="https://www.ajpmonline.org/article/S0749-3797(18)32357-2/fulltext">have had little effect on consumers’ food intake and body mass index</a>.</p>
<p>So what should policymakers do? I think it is time to take several new approaches.</p>
<h2>Economic models for health intervention</h2>
<p>The intellectual property rights of companies that develop novel approaches to weight loss, such as mimicking the effects of exercise, should be protected and rewarded with patent law and other mechanisms. Currently, if a company discovers a way to get people to go for a walk with a new app or program, protection for intellectual property and reimbursement is uncertain. </p>
<p>Given the stakes, the U.S. government should offer greater rewards for behavioral interventions that can demonstrate long-term gains under the same rigorous regulatory standards similar to those required of new drugs. U.S. companies invest <a href="https://www.forbes.com/sites/johnlamattina/2018/06/12/pharma-rd-investments-moderating-but-still-high/#33152bc06bc2">billions of dollars to develop pharmaceuticals</a>. By contrast, there is <a href="https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.05187">less social investment</a> in other prevention activities. </p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/310535/original/file-20200116-181639-6cswc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/310535/original/file-20200116-181639-6cswc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310535/original/file-20200116-181639-6cswc5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310535/original/file-20200116-181639-6cswc5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310535/original/file-20200116-181639-6cswc5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310535/original/file-20200116-181639-6cswc5.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310535/original/file-20200116-181639-6cswc5.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Excess weight carries great social cost.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Overweight-Kids-Diabetes/1771374a081541b5b5775ebf9418056f/5/0">Patrick Sison/APImages.com</a></span>
</figcaption>
</figure>
<p>While not a solution for everyone, gastric bypass and adjustable gastric banding, among other procedures, have proven effective. New incentives could expand access to these surgeries by lowering the BMI threshold for eligibility. Some insurers have put up barriers to this treatment because obesity is not immediately life-threatening or related to our <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6179496/">traditional notion of disease</a>. </p>
<p>We need to find better ways to annuitize the cost of surgery and increase access while tying reimbursement to outcomes. Other insurers with an interest in long-term outcomes, <a href="https://www.wsj.com/articles/health-cares-killer-app-life-insurance-11553122054">including the life insurance industry</a>, can play an important role. They have a vested financial interest in avoiding mortality and disability but have traditionally remained on the sidelines while Americans grow fatter.</p>
<p>Evidence points to <a href="https://doi.org/10.1016/j.jhealeco.2012.04.006">a 20% reduction</a> in BMI persisting up to 10 years after surgery. In 2017, <a href="https://asmbs.org/articles/new-study-finds-most-bariatric-surgeries-performed-in-northeast-and-fewest-in-south-where-obesity-rates-are-highest-and-economies-are-weakest">228,000 Americans</a> received bariatric surgeries. Of those, only 10% of are eligible under current criteria. </p>
<p>Another approach is to consider <a href="https://www.niddk.nih.gov/health-information/weight-management/prescription-medications-treat-overweight-obesity">new medications</a> and utilize the successful approach that has been used to fight high blood pressure. About 50 years ago, hypertension was considered untreatable. Diet and exercise were the predominant means of controlling it. The discovery of multiple agents to combat hypertension, beginning with diuretics and beta blockers, proved transformative. A similar story emerged for elevated cholesterol. About half the decline in U.S. deaths from coronary heart disease can be attributed to <a href="https://doi.org/10.1056/NEJMsa053935">medical therapies</a> like these.</p>
<p>Several clinically proven anti-obesity medications are already available for people who do not respond to lifestyle modification. Furthermore, there is a robust clinical pipeline, with approximately <a href="https://www.pharmaceutical-technology.com/comment/obesity-pipeline/">250 compounds under development</a>, including dozens of novel compounds. Drugs such as these can help change the trajectory of the obesity epidemic, if they are made widely available and reimbursed — challenges in today’s health care insurance system.</p>
<p>Another avenue to consider includes <a href="https://www.taxpolicycenter.org/briefing-book/how-do-state-and-local-soda-taxes-work">levying taxes on sweetened beverages</a>, or the so-called “soda tax.” <a href="https://www.ncbi.nlm.nih.gov/pubmed/26094232">One study</a> found that implementing a 1 cent per ounce soda tax would reduce sugar-sweetened beverage consumption by 20% over 10 years. The result would be a $23.6 billion savings in health care and improved population health. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/310533/original/file-20200116-181634-1pg3a71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/310533/original/file-20200116-181634-1pg3a71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/310533/original/file-20200116-181634-1pg3a71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/310533/original/file-20200116-181634-1pg3a71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/310533/original/file-20200116-181634-1pg3a71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/310533/original/file-20200116-181634-1pg3a71.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/310533/original/file-20200116-181634-1pg3a71.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/310533/original/file-20200116-181634-1pg3a71.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">In 2012, new laws required schools to limit salt and fat and cap calories.</span>
<span class="attribution"><a class="source" href="http://www.apimages.com/metadata/Index/Lunch-Debt-Donors/e71ef26a17da43eca4647608d0bac984/2/0">Mary Esch/APImages</a></span>
</figcaption>
</figure>
<p>Finally, the food and restaurant industry deserves some of the blame. Restricting access – like the United States tried with the ban on the consumption and sale of alcohol – won’t work. But <a href="https://www.rand.org/blog/2014/01/the-conspiracy-to-keep-you-fat.html">responsible steps to regulate portions might</a>.</p>
<p>Smart, bold strategies helped us address public health crises before, including smoking and hypertension. We need to be similarly aggressive with obesity if we want to avert hundreds of thousands of unnecessary deaths. As we did with smoking, it is time to make obesity a number one public health priority.</p>
<p>[ <em><a href="https://theconversation.com/us/newsletters?utm_source=TCUS&utm_medium=inline-link&utm_campaign=newsletter-text&utm_content=expertise">Expertise in your inbox. Sign up for The Conversation’s newsletter and get a digest of academic takes on today’s news, every day.</a></em> ]</p><img src="https://counter.theconversation.com/content/129317/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Dr. Goldman is a consultant to Precision Health Economics and holds equity (<1%) in its parent company. He also reports grants from NIH, an honorarium from ACADIA Pharmaceuticals, and consulting for Novo Nordisk. </span></em></p>Nearly 40% of Americans are obese, and the numbers are climbing. The U.S. needs to get serious about solutions.Dana Goldman, Leonard D. Schaeffer Chair and Distinguished Professor of Public Policy, Pharmacy, and Economics, University of Southern CaliforniaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1193512019-07-11T19:32:38Z2019-07-11T19:32:38ZHow heat waves increase your craving for sodas: findings from Mexico<figure><img src="https://images.theconversation.com/files/282318/original/file-20190702-126350-tutl3z.jpg?ixlib=rb-1.1.0&rect=170%2C520%2C5820%2C3467&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">A man reading a coke bottle in San Juan Teotihuacán, Mexico.
</span> <span class="attribution"><a class="source" href="https://unsplash.com/photos/wOhOp92KKMc">Jordan Crawford/Unsplash</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Unseasonably hot weather <a href="https://weather.com/news/international/news/2019-06-22-europe-heat-wave-june-records">hit Europe this June</a>, giving residents and visitors a taste of what could possibly become common in the near future. With ongoing climate change, temperatures are predicted to rise by 0.3-0.7°C by 2035, according to the <a href="https://www.ipcc.ch/site/assets/uploads/2018/05/SYR_AR5_FINAL_full_wcover.pdf">IPCC</a>.</p>
<p>For policymakers, it is crucial to understand how our planet’s changing climate could affect the food and drink that humans consume. Up to now, much of the research has focused on agricultural productivity – for example, how <a href="https://doi.org/10.1093/ajae/aaw042">higher temperatures affect crop yields</a> over the course of a <a href="https://doi.org/10.1016/j.worlddev.2018.08.006">growing season</a> – yet our forthcoming research in Mexico shows that families’ food habits also changed in response to unusually hot weather. </p>
<p>Better understanding whether and how consumers react to rising temperatures could help mitigate potentially negative consequences of unhealthy diets. </p>
<h2>The powerful “cravings” channel</h2>
<p>Hot weather influences food consumption patterns through two main channels. The first is physiological: as the thermometer climbs and we begin to sweat, our bodies encourage us to drink more water to replace lost fluids and regulate body temperature. From a physiological perspective, there is no reason why humans should drink any fluid other than water in response to high temperatures.</p>
<p>But we can’t ignore the powerful “cravings” channel. Extensive research has shown that salty snacks and sugary drinks share some characteristics with <a href="https://journals.lww.com/co-clinicalnutrition/Abstract/2010/07000/Neurobiology_of_food_addiction.3.aspx">addictive products such as tobacco</a>. This suggests that as temperatures rise, some individuals can feel an <a href="https://www.aeaweb.org/articles?id=10.1257/0002828043052222">overpowering urge</a> to satisfy their thirst not with water, <a href="https://doi.org/10.1006/obhd.1996.0028">but sugar-sweetened beverages</a>. </p>
<p>According to <a href="http://www.theses.fr/s154795">our research</a>, individuals with a preference for sweetened drinks are more likely to give in to their cravings during heat waves. Given that <a href="https://www.smh.com.au/lifestyle/health-and-wellness/climate-change-could-affect-the-way-we-exercise-20170425-gvrt96.html">exercise rates fall as temperatures rise</a>, it seems unlikely that the additional sugar consumed will be offset with more physical activity. The end result will be more calories consumed and, eventually, weight gained.</p>
<h2>Obesity and health</h2>
<p>Obesity levels have been rising around the world for decades. In 1975, the average rate was 11.1% in North America and Europe, and by 2016, it had <a href="https://ourworldindata.org/obesity">more than doubled</a>. In the United States, the <a href="https://www.niddk.nih.gov/health-information/health-statistics/overweight-obesity">average rate for all adults was 37%</a> in 2014, with even higher rates for certain ethnic groups. Excess weight and obesity can cause a range of diseases, including heart problems, diabetes, and certain types of cancer. These in turn impose a heavy economic burden on society, including <a href="https://www.ncbi.nlm.nih.gov/pubmed/28456416">health care expenditures</a> that add <a href="https://www.ncbi.nlm.nih.gov/pubmed/22094013">financial pressure</a> on <a href="https://www.nejm.org/doi/full/10.1056/NEJMra1203528">health care systems</a>.</p>
<p>Along with countries in North and South America, Australasia and Western Europe, Mexico has an average consumption of sugary beverages that greatly exceeds the World Health Organization’s recommendation of <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4733620/">50 grams of sugar per day</a> (approximately 10 teaspoons). A direct result is that country has the <a href="https://www.oecd.org/els/health-systems/Obesity-Update-2017.pdf">second-highest obesity rate among OECD countries</a>. </p>
<h2>How weather influences consumption patterns</h2>
<p>Mexico sits close to the equator, making it prone to <a href="https://iopscience.iop.org/article/10.1088/1748-9326/11/5/055007">strong variations in weather</a>. Temperatures can peak at <a href="http://www.thebigwobble.org/2018/06/mexico-burning-life-threatning.html">close to 50°C</a> (122°F) and heat waves have become <a href="https://www.sciencedirect.com/science/article/pii/S1474706515000789">more frequent</a> in recent years. </p>
<p>In our research, we combined survey data on daily food expenditures for about 85,000 Mexican households with meteorological data on daily outdoor temperatures from the Mexican National Water Commission (CONAGUA). The survey includes diaries on daily food consumption and expenditures over the course of one week for each household and survey wave (2008, 2010, 2012 and 2014) <a href="https://www.inegi.org.mx/programas/enigh/nc/2014/">(Encuesta Nacional de Ingresos y Gastos de los
Hogares)</a> </p>
<p>Given the short study period, our estimations do not capture weather-induced changes in food production and thereby food supply. Therefore, our results are informative about consumers’ short-term responses to rising temperatures without changes in the food products being offered. We also compared individuals’ food-shopping behaviour in the same municipality on cooler and hotter days. With this approach, we were able to rule out behavioural differences due to varying conditions across municipalities, such as different climatic zones or variations in available food products and prices.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/282312/original/file-20190702-126345-18gy3tl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/282312/original/file-20190702-126345-18gy3tl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=450&fit=crop&dpr=1 600w, https://images.theconversation.com/files/282312/original/file-20190702-126345-18gy3tl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=450&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/282312/original/file-20190702-126345-18gy3tl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=450&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/282312/original/file-20190702-126345-18gy3tl.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=566&fit=crop&dpr=1 754w, https://images.theconversation.com/files/282312/original/file-20190702-126345-18gy3tl.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=566&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/282312/original/file-20190702-126345-18gy3tl.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=566&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Excess of sugar during heat waves is bad for your blood!</span>
<span class="attribution"><a class="source" href="https://search.creativecommons.org/photos/3d251ce7-5da8-4c79-9afb-a1856bc2ed2a">elizaIO/Flickrs</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span>
</figcaption>
</figure>
<p>Our results show that Mexican consumers increase their soda and juice consumption by about 20% in weeks where daily temperatures rise above 32°C (90°F) compared to days with temperatures below 22°C (72°F). At the same time, we did not see a significant increase in consumption of water, itself significant given that fountains and other public sources of free drinking water are not frequently available in Mexico.</p>
<p>These findings support the “cravings” channel hypothesis, suggesting that individuals with a preference for sugary beverages find it more difficult to resist as temperatures rise. We further document that these consumption responses translate into slightly higher body mass index (BMI) levels, in particular for <a href="https://www.nap.edu/read/11813/chapter/8">young women</a>.</p>
<h2>Is more information enough?</h2>
<p>A range of public-policy approaches to reduce the consumption of sugary drinks during hot days are possible. Mexico has already taken action to inform consumers about the related health risks, and our findings indicate that they can be effective if rolled out just before or during summer months. Weather forecasts on TV and the Internet could also be accompanied by short messages reminding individuals to drink water instead of sodas. </p>
<p>Another approach is making <a href="https://www.cambridge.org/core/journals/public-health-nutrition/article/sugarsweetened-beverage-taxation-an-update-on-the-year-that-was-2017/613B1B139D15C1F152EA5920DD357E2B/core-reader#">sugary beverages more expensive</a> than healthier alternatives, water in particular. In 2014 Mexico implemented a <a href="https://time.com/4168356/mexico-sugar-drink-soda-tax/">tax on sugar</a>, and the initial results indicate that <a href="https://doi.org/10.3945/jn.117.251892">sales of affected beverages dropped moderately</a>. Authorities can also <a href="https://theconversation.com/taxes-on-sugary-beverages-are-not-enough-on-their-own-to-halt-march-of-obesity-in-asia-84236">restrict sales</a> in certain areas, such as nearby schools, or during certain periods. </p>
<p>Fountains or other sources of drinking water are also needed in public spaces. They would give consumers a free and healthy alternative to purchasing a sugar drink.</p>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/Yw5S9LhVeDA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Awareness campaign to prevent obesity and overconsumption of sodas.</span></figcaption>
</figure>
<p>A more radical approach would be to simply ban sugary beverages during the summer for public health reasons. This is similar to prohibiting outdoor fires to reduce the risk of wildfires. The soda and fast-food industry has consistently lobbied to <a href="https://www.forbes.com/sites/robwaters/2017/06/21/soda-and-fast-food-lobbyists-push-state-preemption-laws-to-prevent-local-regulation/#50538ec2745d">block local regulations on their products</a>, however, and it remains to be seen whether policymakers will be able to implement such an ambitious approach.</p>
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<img alt="" src="https://images.theconversation.com/files/202296/original/file-20180117-53314-hzk3rx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/202296/original/file-20180117-53314-hzk3rx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=121&fit=crop&dpr=1 600w, https://images.theconversation.com/files/202296/original/file-20180117-53314-hzk3rx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=121&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/202296/original/file-20180117-53314-hzk3rx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=121&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/202296/original/file-20180117-53314-hzk3rx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=152&fit=crop&dpr=1 754w, https://images.theconversation.com/files/202296/original/file-20180117-53314-hzk3rx.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=152&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/202296/original/file-20180117-53314-hzk3rx.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=152&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<p><em>Created in 2007 to help accelerate and share scientific knowledge on key societal issues, the AXA Research Fund has been supporting nearly 600 projects around the world conducted by researchers from 54 countries. To learn more, visit the site of the <a href="https://www.axa-research.org/en/">AXA Research Fund</a>.</em></p><img src="https://counter.theconversation.com/content/119351/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Oberlander a reçu des financements de AXA Research Fund. </span></em></p><p class="fine-print"><em><span>Ximena Játiva ne travaille pas, ne conseille pas, ne possède pas de parts, ne reçoit pas de fonds d'une organisation qui pourrait tirer profit de cet article, et n'a déclaré aucune autre affiliation que son organisme de recherche.</span></em></p>New research indicates that rising temperatures can push those who prefer sweets to drink more sugary beverages, not water. This has significant implications for public-health policy.Lisa Oberlander, PhD student in nutrition and health economics, Paris School of Economics – École d'économie de ParisXimena Játiva, PhD student in development economics, University of FribourgLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/961812018-05-17T10:42:12Z2018-05-17T10:42:12ZDiet soda may be hurting your diet<figure><img src="https://images.theconversation.com/files/218510/original/file-20180510-34027-134a0es.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Coca-Cola is the world's most popular carbonated soft drink. The original is made with sugar, but the others contain artificial sweeteners that are now linked to a rise in obesity and diabetes.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/230138068?src=NUy_997g4GskZiRl7oIRGQ-1-80&size=huge_jpg">By Chones/shutterstock.com</a></span></figcaption></figure><p>Artificial sweeteners are everywhere, but the jury is still out on whether these chemicals are harmless. Also called non-nutritive sweeteners, these can be synthetic – such as saccharin and aspartame – or naturally derived, such as steviol, which comes from the Stevia plant. To date, the U.S. Food and Drug Administration has approved <a href="https://www.fda.gov/Food/IngredientsPackagingLabeling/FoodAdditivesIngredients/ucm397725.htm">six types of artificial and two types of natural non-nutritive sweeteners</a> for use in food. </p>
<p>That’s been great news for those working hard to curb their sugar consumption. <a href="https://doi.org/10.3945/ajcn.111.030833">Aspartame</a>, for example, is found in more than 6,000 foods worldwide, and about 5,000-5,500 tons are consumed every year in the United States alone. </p>
<p>The American Diabetes Association – the most well-respected professional group focusing on diabetes – <a href="http://www.diabetes.org/food-and-fitness/food/what-can-i-eat/making-healthy-food-choices/what-can-i-drink.html">officially recommends diet soda as an alternative</a> to sugar-sweetened beverages. To date, seven U.S. municipalities have imposed a sugary beverage tax to discourage consumption.</p>
<p>However, recent medical studies suggest that policymakers eager to implement a soda tax may also want to include diet drinks because these sweeteners may be contributing to chronic diabetes and cardiovascular diseases as well.</p>
<h2>Why are these sweeteners calorie-free?</h2>
<p>The key to these virtually calorie-free sweeteners is that they are not broken down during digestion into natural sugars like glucose, fructose and galactose, which are then either used for energy or converted into fat. </p>
<p>Non-nutritive sweeteners have different byproducts that are not converted into calories. Aspartame, for example, undergoes a different metabolic process that doesn’t yield simple sugars. Others such as saccharin and sucralose are not broken down at all, but instead are absorbed directly into the bloodstream and excreted in the urine. </p>
<p>Theoretically, these sweeteners should be a “better” choice than sugar for diabetics. Glucose stimulates release of insulin, a hormone that regulates blood sugar levels. Type 2 diabetes occurs when the body no longer responds as well to insulin as it should, leading to higher levels of glucose in the blood that damages the nerves, kidneys, blood vessels and heart. Since non-nutritive sweeteners aren’t actually sugar, they should sidestep this problem.</p>
<h2>Artificial sweeteners, your brain and your microbiome</h2>
<p>However, there is growing evidence over the last decade that these sweeteners can alter healthy metabolic processes in other ways, specifically in the gut. </p>
<p>Long-term use of these sweeteners has <a href="https://doi.org/10.2337/dc08-1799">been associated with a higher risk of Type 2 diabetes</a>. Sweeteners, such as saccharin, have been shown to <a href="http://doi.org/10.1038/nature13793">change the type and function of the gut microbiome</a>, the community of microorganisms that live in the intestine. Aspartame <a href="https://doi.org/10.1139/apnm-2016-0346">decreases the activity of a gut enzyme</a> that is normally protective against Type 2 diabetes. Furthermore, this response may be exacerbated by the “mismatch” between the body perceiving something as tasting sweet and the expected associated calories. The greater the discrepancy between the sweetness and actual caloric content, the <a href="http://doi.org/10.1016/j.cub.2017.07.018">greater the metabolic dysregulation</a>.</p>
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<p>Sweeteners have also been shown to change brain activity associated with eating sweet foods. A functional MRI exam, which studies brain activity by measuring blood flow, has shown that sucralose, compared to regular sugar, <a href="https://doi.org/10.1016/j.appet.2011.12.001">decreases activity in the amygdala</a>, a part of the brain involved with taste perception and the experience of eating. </p>
<p>Another study revealed that longer-term and higher diet soda consumption are linked to <a href="https://doi.org/10.1016/j.physbeh.2012.05.006">lower activity in the brain’s “caudate head,”</a> a region that mediates the reward pathway and is necessary for generating a feeling of satisfaction. Researchers have hypothesized that this decreased activity could lead a diet soda drinker to compensate for the lack of pleasure they now derive from the food by increasing their consumption of all foods, not just soda. </p>
<p>Together these cellular and brain studies may explain why people who consume sweeteners still have a <a href="https://doi.org/10.1371/journal.pone.0167241">higher risk of obesity</a> than individuals who don’t consume these products. </p>
<p><a href="https://doi.org/10.1503/cmaj.161390">As this debate on the pros and cons of these sugar substitutes rages on</a>, we must view these behavioral studies with a grain of salt (or sugar) because many diet soda drinkers – or any health-conscious individual who consumes zero-calorie sweeteners – already has the risk factors for obesity, diabetes, hypertension or heart disease. Those who are already overweight or obese may turn toward low-calorie drinks, making it look as though the diet sodas are causing their weight gain.</p>
<p>This same group may also be less likely to moderate their consumption. For example, those people may think that having a diet soda multiple times a week is much healthier than drinking one case of soda with sugar.</p>
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<p>These findings signal that consumers and health practitioners all need to check our assumptions about the health benefits of these products. Sweeteners are everywhere, from beverages to salad dressing, from cookies to yogurt, and we must recognize that there is no guarantee that these chemicals won’t increase the burden of metabolic diseases in the future. </p>
<p>As a physician of internal medicine specializing in general prevention and public health, I would like to be able to tell my patients what the true risks and benefits are if they drink diet soda instead of water. </p>
<p>Legislators considering soda taxes to encourage better dietary habits perhaps should think about including foods with non-nutritive sweeteners. Of course, there is an argument to be made for being realistic and pursuing the lesser of two evils. But even if the negative consequences of sugar substitutes doesn’t sway our tax policy – for now – at least the medical community should be honest with the public about what they stand to lose or gain, consuming these foods. </p>
<p><a href="https://theconversation.com/las-bebidas-light-pueden-perjudicar-tu-dieta-98534"><em>Leer en español</em></a>.</p><img src="https://counter.theconversation.com/content/96181/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Eunice Zhang does not work for, consult, own shares in or receive funding from any company or organization that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Mounting evidence suggests that artificial sweeteners are linked to chronic health problems like obesity and diabetes. Should there be a tax on these foods?Eunice Zhang, Clinical Instructor, University of California, Los AngelesLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/601302016-06-10T10:10:28Z2016-06-10T10:10:28ZIn obesity fight, UK’s heavy-handed soda tax beats US’ watered-down warning<p>Soda drinks are under attack in the US and the UK, but the weapons employed on the two fronts are different. </p>
<p>In the US, San Francisco <a href="http://time.com/3915485/san-francisco-soda-warning-label/">enacted a law</a> last year that requires advertisements for soda and sweetened drinks to alert consumers: “WARNING: drinking beverages with added sugar(s) contributes to obesity, diabetes and tooth decay.” The law <a href="http://www.usatoday.com/story/money/2016/05/18/soda-makers-must-issue-ad-warning-san-francisco/84532214/">was set to take effect</a> in July but was <a href="http://www.wsj.com/articles/san-franciscos-sugary-drinks-warnings-delayed-pending-appeal-1465404121">just put on hold</a> by a federal judge, pending appeal. </p>
<p>On the other side of the Atlantic, UK Prime Minister David Cameron announced the introduction of a “<a href="http://www.theguardian.com/politics/2016/mar/19/sugar-tax-all-fizz-or-weighty-blow-obesity">soda tax</a>.” Starting in April 2018, a tax of 24 pence (36 cents) and 18 pence will be levied on each liter of high-sugar or low-sugar fizzy drinks, respectively. The tax is not only intended to cut soda consumption, but is projected to raise <a href="http://www.theguardian.com/news/datablog/2016/mar/16/will-a-sugar-tax-actually-work-budget">£520m</a> (US$757m) in revenue in the first year alone. </p>
<p>Which of these approaches is more likely to accomplish its intended goal, a reduction in obesity? </p>
<p>Evidence from behavioral, economic and health research suggests that the heavy-handed approach is not only more likely to succeed, but in fact does not go far enough. </p>
<h2>Two approaches to policy</h2>
<p>The difference between the above US and UK approaches to the obesity epidemic raging in both countries reflects more general differences in policy: the UK tends to have a heavy hand, while the US adopts a lighter touch.</p>
<p>For example, governments in both countries have grown alarmed with low savings for retirement – resulting in large part from the transition from plans with defined benefits to plans with defined contributions (a euphemism for “save for your own retirement”). As a result, both countries have enacted legislation aimed at getting more employees to save by automatically enrolling them in a retirement savings plan.</p>
<p>The <a href="https://www.gov.uk/workplace-pensions-employers">UK approach</a>, however, is much more aggressive, mandating – rather than encouraging, as in the U.S. – automatic enrolment. Employers must pay a contribution alongside their employees. Right now, the minimum contribution is 2% of salary with both paying half, but from 2019 that will climb to 8%, with 3% paid by the employer. The government pitches in with tax relief on contributions. Early withdrawals are prohibited, and there is already <a href="http://citywire.co.uk/new-model-adviser/news/webb-new-govt-must-prioritise-pension-auto-escalation/a797743">increasing pressure</a> to ramp up contribution levels still further. </p>
<p>Differences between the UK and US approaches to health care are even more striking, but too <a href="http://www.health.org.uk/sites/default/files/HowDoesTheNHSCompareWithHealthSystemsInOtherCountries.pdf">well-known</a> to warrant describing.</p>
<p>On the other hand, Philadelphia may soon be following the UK’s more heavy-handed approach. The <a href="http://www.nytimes.com/2016/06/09/upshot/novel-strategy-puts-big-soda-tax-within-philadelphias-reach.html?_r=0">city council plans to hold a final vote</a> on June 16 on whether to pass a 1.5 cent per ounce tax on sweetened drinks, which would be the first soda tax in the US.</p>
<h2>Lessons from the war on tobacco</h2>
<p>The war on tobacco has taught us some <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(05)66521-X/fulltext">valuable lessons</a> about which approaches have been most successful at <a href="http://www.who.int/gho/tobacco/policies/en/">curtailing smoking</a>, from warnings and taxes to outright bans. </p>
<p>For example, there is <a href="http://www.who.int/tobacco/global_report/2015/en/">mixed evidence</a> that <a href="http://www.cochrane.org/CD011244/TOBACCO_tobacco-packaging-design-reducing-tobacco-use">warning labels alone</a> reduce cigarette consumption. </p>
<p>On the other hand, there is much <a href="http://www.bmj.com/content/321/7257/358.short">stronger evidence</a> that the <a href="http://tobaccocontrol.bmj.com/content/8/2/196.full">combination</a> of warnings, <a href="http://tobaccocontrol.bmj.com/content/21/2/172.full">higher taxes</a> and <a href="http://www.cochrane.org/CD005992/TOBACCO_does-legislation-ban-smoking-reduce-exposure-secondhand-smoke-and-smoking-behaviour">bans</a> on smoking in <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(15)60521-9/fulltext?rss%3Dyes">public environments</a> together have had a substantial impact.</p>
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<a href="https://images.theconversation.com/files/125981/original/image-20160609-7096-l6csbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/125981/original/image-20160609-7096-l6csbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/125981/original/image-20160609-7096-l6csbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=774&fit=crop&dpr=1 600w, https://images.theconversation.com/files/125981/original/image-20160609-7096-l6csbr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=774&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/125981/original/image-20160609-7096-l6csbr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=774&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/125981/original/image-20160609-7096-l6csbr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=973&fit=crop&dpr=1 754w, https://images.theconversation.com/files/125981/original/image-20160609-7096-l6csbr.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=973&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/125981/original/image-20160609-7096-l6csbr.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=973&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">A company put up posters like these in its cafeterias to steer employees away from sugary sodas and toward zero-calorie beverages. It didn’t work.</span>
<span class="attribution"><span class="license">Author provided</span></span>
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<h2>Labels alone don’t work</h2>
<p>So is there any scientific support for San Francisco’s soda warning? In general, there is very little evidence that <a href="http://content.healthaffairs.org/content/28/6/w1110.full">calorie labels</a> or warnings about added sugars will have much of an effect. </p>
<p>Most studies have shown that simply informing people about the caloric content of food and drink <a href="http://www.cmu.edu/dietrich/sds/docs/loewenstein/EatingByTheNumbers.pdf">has little impact</a> on how much they consume. Nor have more creative approaches, such as telling consumers how many minutes they would have to run on a <a href="http://www.cmu.edu/dietrich/sds/docs/loewenstein/ImpactPriceDiscounts.pdf">treadmill</a> to burn off the calories from a can of soda. </p>
<p>The best prospect for labeling to have an effect is through a kind of <a href="http://www.annualreviews.org/eprint/5tASysE9n8dAIecvtVkK/full/10.1146/annurev-economics-080213-041341">“Tell-tale Heart” effect</a>, whereby food retailers and producers change their offerings or improve the nutritional content of existing selections in response to feared consumer reactions, even if such fears are only imaginary, like in the eponymous Edgar Allan Poe story. </p>
<h2>How about a soda tax?</h2>
<p>Realistically, there isn’t a lot of evidence that a soda tax will have much of an impact either, certainly on obesity but even on <a href="http://www.ifs.org.uk/uploads/budgets/budget2016/budget2016_ks.pdf">soda consumption</a> itself. </p>
<p>More worryingly, a soda tax is <a href="http://www.ifs.org.uk/bns/bn49.pdf">regressive</a> because low-income families tend to consume more soda than more affluent families. The new policy adds yet one more tax on activities, such as smoking, drinking and playing the lottery, that lower-income individuals are more likely to engage in. </p>
<p>If the tax had a disproportionately greater impact on how much soda and calories lower-income people consume, then the overall effect would be less regressive. But existing research provides little grounds for hope that a soda <a href="http://www.ifs.org.uk/publications/8203">tax</a>, by itself, will do so.</p>
<h2>Tip of iceberg</h2>
<p>Furthermore, why target soda for a tax when low pop prices are just the tip of the iceberg of the mispricing of unhealthy foods? In our view, the main problem with the soda tax is that it doesn’t go far enough. </p>
<p>All forms of “<a href="https://global.oup.com/academic/product/fat-economics-9780199213863?cc=gb&lang=en&">junk food</a>,” not just soda, have become progressively cheaper than healthy alternatives in recent decades. According to <a href="http://www.annualreviews.org/doi/abs/10.1146/annurev.publhealth.26.021304.144628">economists</a>, this is largely responsible for the <a href="http://www.keepeek.com/Digital-Asset-Management/oecd/social-issues-migration-health/obesity-and-the-economics-of-prevention_9789264084865-en#page1">obesity epidemic</a>. </p>
<p>Moreover, the attraction of nutritionally poor food arises not only from its low, and dropping, monetary cost, but also by time costs. Personal time constraints further enhance the appeal of prepared and takeaway foods. </p>
<p>What is more, “supersizing” practices, such as pricing large and high-calorie meals in ways that make them seem like deals, are common in the food and retail industries, and likely to be especially attractive to families who are financially strapped. The <a href="http://www.voxeu.org/article/changing-economic-factors-and-rise-obesity">ubiquitous availability</a> of junk food creates a constant temptation for consumers, particularly for those from <a href="http://www.voxeu.org/article/obesity-s-rise-let-s-have-courage-tax-junk-food">low-income families</a>, who often reside in neighborhoods with little access to good-quality or fresh food. </p>
<h2>A comprehensive approach</h2>
<p>One possible rationale for a soda tax is that the government should start by attacking the most egregious problems, and sweetened drinks are an especially attractive bull’s-eye for policymakers given their lack of almost any nutritional component. They’re also the single <a href="https://www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/">largest source</a> of sugars for children aged 11 to 18. </p>
<p>But to have any prospect of significantly improving diet, a more comprehensive “junk food tax” would have to be levied on a much <a href="http://www.theguardian.com/commentisfree/2016/mar/20/sugar-tax-good-idea-go-after-processed-foods-next">broader range</a> of <a href="http://www.ifs.org.uk/uploads/publications/bns/BN180.pdf">sugary</a>, fatty and <a href="http://www.nhs.uk/Livewell/Goodfood/Pages/the-eatwell-guide.aspx">nutritionally poor foods and drinks</a>. </p>
<p>If only soda is taxed, moreover, there is the risk of unintended <a href="http://www.sciencedirect.com/science/article/pii/S0167487014001068">compensatory effects</a> in which consumers end up indulging more in other unhealthy, and tax-exempt, foods or drinks. </p>
<p>To be really effective, such a tax on junk food should be combined with a comprehensive assault on the problem – similar to the fight against tobacco. This should include subsidizing health foods, like fruits and vegetables, as well as regulating ads. </p>
<p>Warning labels can be a part of this, but governments hoping to turn the tide on the obesity epidemic should also regulate unhealthy default options on menus, and supersizing practices – such as former New York City Mayor Michael Bloomberg’s <a href="http://www.bloomberg.com/news/articles/2014-06-26/new-york-big-soda-ban-rejected-by-n-y-top-court-as-overreach">failed effort</a> to ban oversized sodas.</p>
<p>At the same time, revenue from any taxes levied should go toward helping low-income families: for example, by subsidizing healthy foods, since low-income families will be most hurt by the tax. </p>
<p>Posting calories and warning consumers is fine as far as it goes, as is a soda tax, but in our view these policies don’t go nearly far enough.</p><img src="https://counter.theconversation.com/content/60130/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Behavioral research shows why a heavy-handed approach like the UK’s soda tax works better than the mere warning that San Francisco wants to put in advertisements.Matteo M. Galizzi, Assistant Professor of Behavioural Science, London School of Economics and Political ScienceGeorge Loewenstein, Professor of Economics and Psychology, Carnegie Mellon UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/565232016-03-21T12:37:17Z2016-03-21T12:37:17ZFizzy drinks tax alone won’t solve childhood obesity nightmare<figure><img src="https://images.theconversation.com/files/115599/original/image-20160318-4432-19epx22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Hola cola</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/s/child+soda/search.html?page=2&thumb_size=mosaic&inline=296920880">Monkey Business Images</a></span></figcaption></figure><p>George Osborne’s <a href="http://news.sky.com/story/1660913/osborne-defends-credibility-after-budget">sugar levy</a> on soft drinks seems to acknowledge, at long last, that the food industry should be regulated to help consumers adopt healthier diets. A substantial body of evidence strongly supports a “soda tax”. Regularly consuming sugary drinks is associated with growing rates of <a href="http://www.sciencedirect.com/science/article/pii/S0140673600040411">obesity</a>, <a href="http://www.sciencedirect.com/science/article/pii/S0031938410000600">diabetes</a> and <a href="http://link.springer.com/article/10.1631/jzus.B0820245">tooth decay</a>, particularly among children. Since <a href="http://www.oecd.org/health/Obesity-Update-2014.pdf">price influences consumption</a>, the tax aims to help steer consumers towards healthier options. </p>
<p>The soft-drinks industry has <a href="http://www.huffingtonpost.com/peter-dreier/the-soda-tax-wars_b_544898.html">loudly objected</a> to the tax on the grounds that it is an intrusion of the “nanny state” on individual choice. But this ignores the fact that consumer choice is shaped to a large extent by the marketing efforts of the soft-drinks manufacturers. In truth this is the health-motivated state taking back some ability to influence consumers from the profit-motivated corporations, finally living up to its responsibility to protect public health and do something about childhood obesity. </p>
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<a href="https://images.theconversation.com/files/115601/original/image-20160318-4456-vy5bby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/115601/original/image-20160318-4456-vy5bby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/115601/original/image-20160318-4456-vy5bby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=758&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115601/original/image-20160318-4456-vy5bby.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=758&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115601/original/image-20160318-4456-vy5bby.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=758&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115601/original/image-20160318-4456-vy5bby.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=952&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115601/original/image-20160318-4456-vy5bby.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=952&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115601/original/image-20160318-4456-vy5bby.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=952&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Breathe in …</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-281904083/stock-photo--childhood-obesity.html?src=csl_recent_image-1">Oleg Malyshev</a></span>
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<p>Soft-drinks manufacturers also argue that food taxes disproportionately affect poor people, since they spend a larger share of their income on food, particularly unhealthy food. The move will therefore exacerbate inequality, they claim. Yet this is a short-term view of inequality: while poorer consumers may spend proportionately more of their income on unhealthy drinks, they <a href="https://nutritionreviews.oxfordjournals.org/content/67/suppl_1/S36">are more likely</a> to be overweight. They may therefore see the greatest health benefits in the longer term. </p>
<h2>Complex problem</h2>
<p>Public support for the soda tax will be higher if the tax is framed as a health-promotion tool, and if the revenues are specifically allocated to obesity-prevention programmes. We should therefore welcome the <a href="http://www.bbc.co.uk/news/health-35824071">chancellor’s announcement</a> that the £520m he expects to raise in year one will be spent on increasing sports funding in primary schools. </p>
<p>Yet the success of this tax will ultimately depend on how effectively it has been designed. Here Osborne still has a lot of thinking to do. His decision to exclude milk-based drinks and pure fruit juices, even though they can be high in sugar, may work against the tax’s health objectives. This is particularly the case if it results in sweetened drinks being substituted for milk-based drinks. </p>
<p>The <a href="http://www.sciencedirect.com/science/article/pii/S0140673614617451">literature</a> suggests these kinds of interventions are most effective when they target the problem precisely and don’t allow consumers unhealthy alternatives. At present the government’s message also appears confused: is the tax designed to discourage consumers from buying so many soft drinks or encourage the manufacturers to reduce their sugar content – or both? The bottom line is that if the soda tax is going to work, it must incentivise consumers to shift from sugary soft drinks to less sugary ones. </p>
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<a href="https://images.theconversation.com/files/115600/original/image-20160318-4417-1s3p8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/115600/original/image-20160318-4417-1s3p8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/115600/original/image-20160318-4417-1s3p8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/115600/original/image-20160318-4417-1s3p8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/115600/original/image-20160318-4417-1s3p8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/115600/original/image-20160318-4417-1s3p8r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/115600/original/image-20160318-4417-1s3p8r.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/115600/original/image-20160318-4417-1s3p8r.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Milky pleasures.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-248233210/stock-photo-raspberry-smoothie.html?src=csl_recent_image-1">magdanatka</a></span>
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<p>The debate surrounding this soda tax highlights that developing effective obesity-prevention strategies is complex. If the government genuinely wants to tackle the problem, it needs to comprehensively address the multiple aspects of childhood obesity. Sugary drinks are an important part of that, but still only a part. The government’s long-awaited and much delayed <a href="http://www.theguardian.com/society/2016/feb/26/childhood-obesity-strategy-delayed-sugar-tax-unlikely">strategy on</a> childhood obesity, promised for this summer, may well build on the soda-tax announcement. Certainly the government still needs to do far more than it has proven willing to do so far to reverse obesity trends.</p><img src="https://counter.theconversation.com/content/56523/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amandine Garde often advises governments, international organisations and NGOs on the role that legal instruments can play in promoting healthier lifestyles. She currently acts as a consultant to the World Health Organization and UNICEF on the regulation of food and alcohol marketing, particularly to children, on the plain packaging of tobacco products and on other policies on the prevention of non-communicable diseases. She does not accept any funding from the food, the tobacco or the alcohol industries.
She received some research funding from the Economic and Social Research Council for a project on the marketing of food and non-alcoholic beverages to children in 2013.</span></em></p><p class="fine-print"><em><span>Kirsten Ward and Oliver Bartlett do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>George’s medicine for health crisis is welcome, but not marvellous.Oliver Bartlett, Lecturer in Law, University of LiverpoolAmandine Garde, Professor of Law, University of LiverpoolKirsten Ward, Pre-doctoral researcher, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.