Sodas and junk food will be taxed more heavily in an effort to curb obesity
Mexico has increased taxes on sodas and junk food in an effort to battle rising obesity rates.
Earlier this year Mexico passed the U.S. as the most obese country in the world, but it is not taking that title willingly. This week the Mexican Congress stepped up with a tax reform bill that will increase taxes on junk foods and sodas in an attempt to curb the country’s rising obesity rates.
“We can’t keep our arms crossed in front of a real overweight and obesity epidemic,” said President Enrique Peña Nieto. “The lives of millions of Mexicans are literally at risk.”
According to The Guardian, 32.8 percent of adult Mexicans are obese, compared with 31.8 percent of adult Americans. Approximately 9.2 percent of children in Mexico have diabetes.
“Obesity and diabetes are affecting school and work performances, and with it, the country’s economic competitiveness,” said Health Minister Mercedes Juan.
As part of the new strategy against obesity, Mexico’s senate approved an 8 percent tax on foods that have more than 275 calories per 100 grams. There will also be a 1-peso or 8-cent per liter tax on sodas. Mexico has one of the highest rates of soda consumption in the world. People in Mexico drink 43 gallons of sodas a year on average.
The money raised by the new junk food tax is earmarked for health programs and increasing access to drinking water in schools.
⟺t tax' on unhealthy food must raise prices by 20% to have effect, says study
"Fat taxes" would have to increase the price of unhealthy food and drinks by as much as 20% in order to cut consumption by enough to reduce obesity and other diet-related diseases, experts have said. Such levies should be accompanied by subsidies on healthy foods such as fruit and vegetables to help encourage a significant shift in dietary habits, according to research published in the British Medical Journal.
Academics led by Dr Oliver Mytton and Dr Mike Rayner of the Department of Public Health at Oxford University examined the evidence from around the world for what they call health-related food taxes. Denmark has brought in a "fat tax", Hungary a "junk food tax" and France a tax on all sweetened drinks. Peru intends to add levies to junk food and Ireland may also introduce such taxes. David Cameron last October said the UK should considering following suit.
While it is unclear how such taxes could be brought in and enforced, they could help ensure that poor diet plays less of a role in future in a range of illnesses such as heart disease, type two diabetes and tooth decay, as well as obesity.
Although the less well-off are affected more by health-related food taxes, they may also ultimately benefit because "progressive health gains are expected because poor people consume less healthy food and have a higher incidence of most diet-related diseases, notably cardiovascular disease", the authors say.
Evidence suggests that bigger health gains result from increasing the price of a broad range of foods rather than a narrow one, and sugary drinks offer the best proof that such a move can be effective. Research in America found that a 35% tax on drinks sweetened with sugar sold in a canteen, which added about 28p to the price, led to a 26% drop in sales. Studies have estimated that a 20% levy on such drinks in the US would cut obesity by 3.5% and that adding 17.5% to the cost of unhealthy food products in the UK could lead to 2,700 fewer deaths from heart disease.
But the food industry attacked the research. "When the whole of the food industry is focused on continuing to give hard-pressed families great tasting food at an affordable price, discussion of adding 20% to food prices seems fanciful if not irresponsible," said Terry Jones, director of communications for the Food and Drink Federation, which represents food producers and retailers. Firms were working with the Department of Health through its Public Health Responsibility Deal "to make meaningful improvements in public health through pledges in areas such as salt and calorie reduction, and our commitment to improving the health of our employees", he added.
Anne Milton, the public health minister, said the Department of Health was keeping an eye on all the evidence emerging internationally about such taxes. She defended the policy of relying on voluntary deals with food firms, which critics have criticised as an inadequate substitute for regulation of the food industry. "We are working with food companies through the Responsibility Deal to reduce calories and ensure healthier options are available. We believe that collective voluntary action can deliver real progress quickly," Milton added.
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Overweight and obesity are well established risk factors for a number of chronic diseases including cardiovascular diseases, cancers and diabetes [1, 2]. The rise in sedentary lifestyles and the increased consumption of energy dense foods has seen worldwide obesity rates more than double since 1980, with the prevalence of chronic disease increasing globally across every region [3, 4]. As a result, overweight and obesity are increasingly recognised as being among the most important public health issues in the world today .
The most recent Australian Health Survey highlights that 28% of adults are now obese, with 63% classified as overweight or obese . Projections suggest that by 2025, the prevalence of overweight and obesity will increase to over 70%, with approximately one third of the adult Australian population classified as obese . Reflecting a similar circumstance globally, WHO member states have introduced a voluntary target to halt the rise in obesity by 2020 .
In addition to its significant health burden, obesity is also responsible for a substantial economic burden. The cost of illness framework provides an approach for estimating the economic burden of disease that incorporates both direct health care resource use, as well as the indirect productivity impacts of illness and death . Such studies are well represented in the medical literature around overweight and obesity, and it has been reported that the direct health care costs associated with these risk factors are significant, accounting for between 2–12% of total health care budgets in developed economies [10–15]. Where these studies have considered the productivity related costs of overweight and obesity, these costs have consistently been found to outweigh the direct health care costs [16–18].
Despite these findings, studies evaluating the cost-effectiveness of public health interventions typically take a health care perspective, with estimates of potential cost savings limited to those associated with health care resource use. The cost-effectiveness outcomes reported in these studies may underestimate the total benefits to society. It follows that decisions regarding the allocation of society’s scare resources towards improving health are often made without full information on the potential economic returns of these investments.
The aim of this study was to estimate the productivity impacts of a tax that would raise prices on unhealthy foods by 10% in an Australian setting. The selected unhealthy food categories included biscuits, cakes, pastries, pies, snack foods, confectionary and soft drinks. We refer to this intervention throughout as the ‘junk food tax’. Our secondary aim was to determine how the inclusion of productivity impacts of a junk food tax influenced the overall cost-effectiveness outcome. We applied microsimulation techniques to project the lifetime working years and income that would accrue for individuals whose premature deaths could be successfully averted under the intervention. Outcomes were modelled to the year 2030 and are presented across a number of age, sex and disease categories.
Visualizing Mexico’s fight against obesity (and junk food)
Mexico recently beat out the United States, though just barely, for having the world’s biggest waistlines. Not coincidentally, the Central American nation is also one of the world leaders in soft drink consumption.
In response to these two unfortunate trends, Mexican lawmakers appear likely to pass a 5% tax on junk food and 8 percent on soda. Through this tax, the government aims to generate billions of dollars in tax revenue and curb a growing obesity epidemic.
There’s a global push to increase efforts against so-called noncommunicable diseases (NCDs) like obesity, diabetes and heart disease – all of which are fueled by poor dietary or lifestyle behaviors.
The food and beverage industry has, since the beginning of this push against NCDs, pushed back against many efforts manufacturers see as singling out ‘fast food’ as bad food. So it is worth taking a closer look at how Mexico fares in its fight against fat.
In Mexico, premature death and disability attributable to high body mass index (BMI), a metric used to measure overweight and obesity, increased 164% between 1990 and 2010, rising from the 7th leading risk factor in 1990 to the number one risk factor in 2010, as shown in the screen grab below from the Global Burden of Disease (GBD) Study 2010.
In 2011, Mexico was the second-largest consumer of soda in the world (second only to the United States) as shown in this map from Slate.com that uses Euromonitor International data.
If this tax is passed, it will be interesting to use the GBD data to monitor trends in disease burden attributable to high BMI in Mexico. The GBD results will be updated annually starting in 2014.
In addition to using the GBD data to monitor trends in premature death and disability from overweight and obesity, these data can also be used to track the health impact of one of the tax’s main targets, sugary beverages. Sugary beverages are one of the 14 dietary risk factors measured by GBD along with other aspects of diet such as low fruit, nut, and seed intake and eating too much processed meat. While dietary risks as a whole were the third leading risk factor for early death and disability in Mexico in 2010 (shown above), within this category, sugary beverages were most important dietary risk factor (see screen grab).
Sugary drinks contribute to diabetes and accounted for 31% of disease burden from this condition in Mexico in 2010 (explore the data here). The negative impact of sugary beverages on health has only increased over time (see screen grab).
I spoke with Bernardo Hernández Prado, a Clinical Associate Professor at the Institute for Health Metrics and Evaluation, about the proposed tax. Dr. Hernández Prado was formerly the head of the Center for Research in Population Health at the National Institute of Public Health in Mexico.
“In Mexico, we first tried to lower obesity among schoolchildren by placing limits on the serving size for junk food,” Prado said. “It didn’t work. When the serving size was reduced, children just bought two bags of chips instead of one. This proposed tax on junk food and sugary drinks is a new experiment to reduce obesity.”
If passed, do you think the tax on sodas and high-calorie foods will succeed in reducing obesity and improving health outcomes in Mexico? Share your thoughts with us via Twitter and Facebook.
Evidence Supporting Sugar Taxes
While sugar taxes are not new, monitoring their impacts on diet and health is relatively recent. With little available data, it is still early to judge their influence on distal population-level health outcomes such as NCD. Nevertheless, the decreased sale of SSB in locations where taxes have now existed for several years [33••, 34, 35••] infers potential for long-term positive health impacts. Furthermore, long-term benefits on diet-related disease prevalence can be potentiated by investing SSB tax revenue into health promotion programs [36•]. While there is still little evidence of an impact of sugar taxes specifically on obesity, there is growing evidence from naturalistic studies in regions where taxes have been implemented that monitor both purchasing habits and health outcomes to support modeling studies, building the case for the continued proliferation of SSB tax implementation [37•].
Modeling and Observational Studies
In 2013, a systematic review identified nine articles between published between 2000 and 2013 that examined the effects of fiscal policies (taxes and price increases) on body mass index (BMI) and weight status . The review identified six modeling studies on BMI, overweight or obesity, all from the USA, with a wide range of methodologies examining various populations (children, women, men, and adults) in different settings [38,39,40,41,42,43,44]. The mix of study designs and populations made it difficult to draw firm conclusions about the effects of taxes or price changes on adiposity, but positive conclusions from numerous studies led review authors to conclude that SSB taxation could reduce obesity .
A retrospective cohort study of 6537 men and 5324 women who participated the Monitoring the Future Surveys (1992–2003) determined that a $1 increase in price of a 2-L bottle of SSB was associated with a reduction in the probability of obesity of 28.1% and 10.8% in women and men, respectively . Among children and adolescents, using NHANES data from 1999 to 2006, a 1% increase in SSB prices was estimated to result in a minute reduction in obesity prevalence by 0.009% . Other modeling studies have found similar conclusions with slight decreases in BMI associated with a 1% increase in SSB prices [38, 43, 44]. American food consumption data from NHANES 2003–2006 were used to model a tax-induced 20% increase in price and calculated a decrease in calorie intake from SSBs by 54.6 kcal/day with a concurrent increase in calories from juices by 12.5 kcal/day. These changes in beverage intake represented a net reduction of 39.5 kcal/day, equivalent to a reduction in weight of 1.9 kg per year . Using data from a single year of the Nielsen Homescan panel, a 20% and 40% tax on SSB was expected to reduce weight by 0.32 kg and 0.59 kg per year, respectively, while generating considerable revenue . A Canadian simulation modeling study predicted that over 25 years, a 20% tax on sugary drinks would prevent over 700,000 cases of overweight and obesity, and over 200,000 cases of type 2 diabetes, saving $11.5 billion (CAD) in direct health care costs and generating $1.7 billion . However, it is impossible to predict how the industry will respond to SSB taxation (e.g., intensify marketing, increase sales in non-taxed markets, or reformulate products) or how consumers will modify their beverage consumption (e.g., substitute taxed SSBs with cheaper sweetened alternatives or select healthier untaxed alternatives).
WHAT IS OBESITY? AND WHAT ARE ITS HEALTH RISKS?
An adult is obese if they have a BMI - body mass index - over 30.
A healthy person's BMI - calculated by dividing weight in lbs by height in inches, and the answer by the height again - is between 18.5 and 24.9.
The US is in the midst of an obesity epidemic, and more than a third of adults are considered obese. Two thirds are overweight or obese, meaning they have BMIs over 25.
Another one in five children are obese as well.
In total, obesity is estimated to cost the US $149 in medical expenses each year. Half of that is paid for through the publicly-funded healthcare programs, Medicaid and Medicare.
Around 35 percent of men and over 40 percent of women in the US are obese, raising their risks of a broad range of chronic diseases and death itself.
Such conditions include type 2 diabetes, which can cause kidney disease, blindness and even limb amputations.
Diabetes costs the US $327 billion a year, and accounts for one in every $7 spent on health care.
Obesity also raises the risk of heart disease, the number one cause of death in the US, responsible for one in every four deaths.
Carrying dangerous amounts of weight has also been linked to 13 different cancers:
- Cancer of the lining of the uterus
- Esophageal cancer
- Stomach cancer
- Liver cancer
- Kidney cancer
- Multiple myeloma
- Pancreatic cancer
- Colorectal cancer
- Ovarian cancer
- Thyroid cancer
- Gallbladder cancer
- Breast cancer
It is suspected that the chronic inflammation associated with obesity damages DNA which, in turn can be carcinogenic.
Meanwhile, convenience food like ready meals and snacks laden in sugar and fat are being increasingly exported from the West to impoverished nations.
Lead study author Barry Popkin, professor of nutrition at the University of North Carolina, said: 'We see this in sub-Saharan Africa, we see it in South Asia, the modern junk food system has reached every nook and cranny.
'Our research shows that overweight and obesity levels of at least 20 per cent among adults are found in all low- income countries.
'Reductions in physical activity and rising sales of food rich in refined carbohydrates, fat, sugar and salt were largely to blame.
'I could take you to the middle of the Congo, one of the world's most isolated regions, and I'd be able to show you junk food.'
The researchers used survey data from low- and middle-income countries in the 1990s and 2010s to estimate which countries had problems with both malnutrition and obesity.
The nations fell into this bracket if more than 30 per cent of their population had stunted growth, over 20 per cent of women were too thin, and more than a fifth were overweight.
In the 2010s, 14 of the poorest countries had developed this double burden of nutrition, compared with the 1990s.
However, fewer countries with middle and high incomes were affected than in the 1990s.
The authors say that this reflects the increasing prevalence of being overweight in the poorest countries, where populations still face malnutrition.
Professor Popkin added: 'Emerging malnutrition issues are a stark indicator of the people who are not protected from the factors that drive poor diets.
'The poorest low- and middle-income countries are seeing a rapid transformation in the way people eat, drink, and move at work, home, in transport and in leisure.
'The new nutrition reality is driven by changes to the food system, which have increased availability of ultra-processed foods that are linked to increased weight gain, while also adversely affecting infant and pre-schooler diets.
'These changes include disappearing fresh food markets, increasing supermarkets, and the control of the food chain by supermarkets, and global food, catering and agriculture companies in many countries.'
The report, which estimates that 2.3billion people across the world are obese, said that obesity in China had been sparked by a 'massive reduction in physical activity'.
Researchers blamed sedentary jobs, modern transport and an increase in the number of women getting work.
Mothers are now choosing to buy processed food that is ready to eat or can be heated up in a microwave, the report said.
Co-study author Dr Francesco Branca, director of the Department of Nutrition for Health and Development at WHO, said: 'We are facing a new nutrition reality.
'We can no longer characterize countries as low-income and undernourished, or high-income and only concerned with obesity.
'All forms of malnutrition have a common denominator – food systems that fail to provide all people with healthy, safe, affordable, and sustainable diets.
'Changing this will require action across food systems – from production and processing, through trade and distribution, pricing, marketing, and labelling, to consumption and waste.
'All relevant policies and investments must be radically re-examined.'
A separate study in The Lancet warned schemes set up to tackle hunger in low income countries were now at risk of making nutrition standards worse.
Researchers from the City, University of London said that supplying rice, sugar and cooking oil to poor families in Egypt had caused obesity levels to rise.
WHAT SHOULD A BALANCED DIET LOOK LIKE?
Meals should be based on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally wholegrain, according to the NHS
• Eat at least 5 portions of a variety of fruit and vegetables every day. All fresh, frozen, dried and canned fruit and vegetables count
• Base meals on potatoes, bread, rice, pasta or other starchy carbohydrates, ideally wholegrain
• 30 grams of fibre a day: This is the same as eating all of the following: 5 portions of fruit and vegetables, 2 whole-wheat cereal biscuits, 2 thick slices of wholemeal bread and large baked potato with the skin on
• Have some dairy or dairy alternatives (such as soya drinks) choosing lower fat and lower sugar options
• Eat some beans, pulses, fish, eggs, meat and other proteins (including 2 portions of fish every week, one of which should be oily)
• Choose unsaturated oils and spreads and consuming in small amounts
• Drink 6-8 cups/glasses of water a day
• Adults should have less than 6g of salt and 20g of saturated fat for women or 30g for men a day
Junk food shortening lives of children worldwide, data shows
Junk food and sugary drinks are taking an enormous toll on children around the world, with soaring numbers who are obese and millions developing conditions such as type 2 diabetes and high blood pressure previously seen only in adults, data has revealed.
Children were facing crippling illnesses and shortened lives because of the spread of the heavily marketed fast-food culture, experts said, and health services around the world would struggle to cope. They predicted that the UN target to stop the rise of childhood obesity by 2025 would be missed.
The three countries with the highest child obesity rates were the South Pacific island nations of Kiribati, Samoa and Micronesia. Among the more populous countries facing the worst scenarios were Egypt – where more than a third (35.5%) of children aged five to 17 were overweight or obese in 2013 – Greece (31.4%), Saudi Arabia (30.5%), the United States (29.3%), Mexico (28.9%) and the UK (27.7%).
More than 3.5 million children now had type 2 diabetes, which was once unknown in this age group and can lead to horrible complications in later life, such as amputations and blindness. The World Obesity Federation, which compiled the data, predicted that number would rise to 4.1 million by 2025.
About 13.5 million children have impaired glucose tolerance, which is a precursor to diabetes. Around 24 million have high blood pressure and more than 33 million have fatty liver disease as a result of obesity, which is more often associated with alcoholism and can lead to cirrhosis and liver cancer.
If anything, the experts said, the figures were an under-estimate because they were based on the numbers of obese children, and some who were classified as overweight would also have the diseases.
The figures are alarming for rich and poor countries alike, signalling soaring medical bills to treat the coming epidemic of disease. But the WOF experts who compiled the data said that, while rich countries were struggling, poorer countries were ill-equipped to cope.
“These forecasts should sound an alarm bell for health service managers and health professionals,” said Tim Lobstein, the policy director of the WOF. “They will have to deal with this rising tide of ill health following the obesity epidemic.
“In a sense, we hope these forecasts are wrong: they assume current trends continue, but we are urging governments to take strong measures to reduce childhood obesity, and meet their agreed target of getting the levels of childhood obesity down to 2010 levels before we get to 2025.”
The experts, whose findings were published in the Pediatric Obesity journal, said that by 2025, 49 million more children would be obese or overweight than in 2010 – a total of 268 million, of which 91 million alone would be obese.
Lobstein, one of the authors of the paper published ahead of World Obesity Day next Tuesday, said the food children were eating was at the heart of the problem and that in poor countries, obesity and stunting went hand in hand.
“We find that the large majority of children suffering excess bodyweight are in low- and middle-income countries. Following the recent evidence from the World Bank on the continuing high levels of stunting in children in underdeveloped regions of the world, it is obvious that something is severely wrong with the way our food supplies are developing,” he said.
“You cannot replace contaminated water with Coca-Cola or Chocolate Nesquik, or a lack of good meals with a pack of fortified noodles, and still expect children to grow healthily. Breastfeeding is rapidly giving way to infant formula in large areas of Asia where markets have tripled in value in a decade – an area where we have seen some of the most rapid increases in overweight and obesity.
“Stunting and obesity are part of a continuum of poor nutrition, and can be found together in the same communities, the same families, and even the same individual children. Health is a key factor in sustainable development, and healthy food supplies are essential for economic development. Healthy food supplies are also a basic human right for this and the next generation.”
The WOF president, Prof Ian Caterson, called for governments to take tough regulatory action to stop junk food companies targeting children.
“The obesity epidemic has reached virtually every country in the world, and overweight and obesity levels are continuing to rise in most places,” he said. “Common risk factors, such as soft drink consumption and sedentary environments, have increased. Fast food advertising continues to really influence food choices and what is eaten, and increasing numbers of families live in urban environments without access to space to exercise or time to exercise.”
In the last 10 years, consumption of sugary drinks worldwide increased by a third. More than half of the world’s population live in urban areas, and 80% of young people aged 11-17 fail to get sufficient physical activity.
“If governments hope to achieve the WHO target of keeping child obesity at 2010 levels, then the time to act is now. Governments can take a number of actions to help prevent obesity, including introducing tough regulations to protect children from the marketing of unhealthy food, ensuring schools promote healthy eating and physical activity, strengthening planning and building rules to provide safe neighbourhoods, and monitoring the impact of these policies.”
Paris to tackle obesity with junk food tax
France is raising the tax on all high calorie foods in an attempt to tackle its increasing weight problem. EURACTIV’s partner Journal de l’Environnement reports.
According to the ObEpi-Roche 2012 survey, 32.3% of French citizens are overweight, with 15% classified as obese. While the country performs better than may other OECD members in this regard, the situation is steadily getting worse.
If France’s overweight population continues to grow at its current rate of 4% per year, it will reach 33 million by 2030, compared to 24.6m in 2012.
In the September issue of its monthly bulletin Trésor-Eco, dedicated to the economic consequences of obesity, France’s Directorate General for the Treasury estimated the total social cost (healthcare, lost productivity, etc.) of obesity at €20.4 billion per year. This places obesity between tobacco (€26.6bn) and alcohol (€15bn) in terms of its cost to the public purse.
WHO warns of burgeoning obesity crisis in Europe
Europe will face an obesity crisis of vast proportions by 2030, according to new World Health Organization projections, with many countries likely to see far more than half of adults above the healthy weight limit.
So how should this epidemic (and its costs) be managed? For Paris, the answer is to introduce a nutrition tax, under which products may be taxed if they contain more than a certain amount of calories. Mexico adopted a similar solution in 2014 to try to rein in its own obesity epidemic, taxing food based on its nutritional quality.
But the problem with this tax, its detractors say, is that it would primarily affect lower income households. Poorer people tend to spend a higher proportion of their income on food and eat less healthily.
“There is no reason why this tax should not be accompanied by measures to redistribute wealth, to boost the purchasing power of the poorest people,” the finance ministry said.
Two ineffective taxes
France currently has two nutritional taxes, applied to well-defined products. But their impact on consumption (and on public health) is weak.
One tax, on sugary and sweetened drinks, brought in a little under €400m in 2014, while the other, on energy drinks like RedBull, raised just €3m. This was far below the €65m that had been predicted, largely because the leading manufacturer of energy drinks cut the cafeine content of its products in order to escape the tax.
Another solution would be to broaden the selection of products on which the top rate of VAT is applicable, following the UK’s model. In France, VAT on all food products is 5.5%, with a few exceptions, like alcohol, caviar, sweets and vegetable fats, which are taxed at 20%. For the Directorate General of the Treasury, “a higher rate could increase the cost of the most harmful products”.
On top of this tax hike, the French Ministry of Economy is considering other measures, like running targeted prevention campaigns, limiting or banning the advertising of unhealthy food products to children, and strenthening the requirements for nutrition labelling.
This last measure is popular among policy-makers, but has so far been blocked by the powerful agri-food industry. Perhaps this does not bode well for an ambitious tax project.
Who is affected?
Hispanic children have the highest prevalence of overweight for children 2 to 5 years of age.
“being from a low-income family, especially a low-income, Mexican-American family, does raise the probability of a child’s being at risk for overweight.” written by Ver Ploeg, Michele. WIC and the Battle Against Childhood Overweight. EB-13, U.S. Department of Agriculture, Economic Research Service. April 2009. Click here to read the full article