Thursday, April 09, 2009

Should we tax sugar sweetened beverages?

In this week's edition of the New England Journal of Medicine is an editorial written by public health crusaders Drs. Kelly Brownell and Thomas Frieden exploring the idea of taxing sugar sweetened beverages.

Unlike putting calories on menus, this would no longer simply be about passing on more information it would be about charging more money.

Basically there are two ways to approach this: Incentive taxation whereby a nominal tax would be applied with the proceeds then going to public health/obesity related initiatives or disincentive taxation whereby you put enough of a tax on the drinks so as to discourage their consumption (or of course a combination of the two).

This wouldn't be an entirely new plan. You may be surprised to know that 40 American States already have small taxes on sugared beverages and snack food and that in Canada there are many different tiers of food taxation.

The argument for taxation is simple. Sugar-sweetened beverages are strongly linked to the obesity epidemic and some argue that they are in fact the single biggest driver of societal weight. They're marketed extensively to children and in the mid 1990s their intake in children surpassed that of milk. Shockingly calories consumed from beverages now account for 10-15% of all the calories consumed by children and adolescents and for every glass consumed per day the likelihood of a child becoming obese increases by 60%. That's one hell of a big gulp.

The authors report that with regards to disincentive taxation, for every 10% increase in price, consumption decreases by 7.8% and estimate that a penny per ounce excise tax would reduce consumption by 13% or two servings per person per week. In turn the tax would generate literally billions of dollars ($1.2 billion in New York State alone) which if used to promote health and better dietary options could have further impact on health and obesity.

Opponents state that food taxes are regressive and unlike tobacco, we need food to live therefore taxation would be unfair, especially when singling out a single food.

Well I've got news for them - we don't in fact need sugar sweetened beverages to live.

As I keep hammering home, to put a dent in rising rates of obesity requires action on a societal level, not an individual one. We need to change the toxic environment itself and taxing one of the main drivers of the epidemic is one way to do that.

This is a war. Sometimes war calls for tough decisions and personally I think this would be a good one.

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  1. Since evidence-based medicine is of top importance to you, I would recommend the following scientific review (in case you haven't seen it):

    Sugar-sweetened Beverages and Body Mass Index in Children and Adolescents: a Meta-analysis.

    Forshee RA, Anderson PA, Storey ML.
    Am J Clin Nutr. 2008 Jun;87(6):1662-71.

    Here is the conclusion from the abstract: The quantitative meta-analysis and qualitative review found that the association between sweetened beverage consumption and BMI was near zero, based on the current body of scientific evidence.

  2. Anonymous10:52 am

    hmm...I believe one of the publishers of the study, Maureen L. Storey was also the Senior Vice President for the Science Policy
    American Beverage Association. Big shocker on their findings.

    Perhaps you should take some time to look at who's involved in the studies before calling it "evidence-based" medicine.

  3. Anonymous12:01 pm

    Anonymous, you can't simply "make up" science and publish it in one of the most credible and prestigious nutrition publications in the world (AJCN). Upon submission for publication, articles are peer-reviwed before they are published, which includes intense scrutiny of the methods, data and concluions.

  4. Sara,

    For a non-industry funded meta analysis (as it seems you like those), feel free to pull the following article: Vartanian, L.R., M.B. Schwartz, and K.D. Brownell. 2007. Effects of Soft
    Drink Consumption on Nutrition andHealth: A Systematic Review
    and Meta-Analysis. American Journal of Public Health 97:667–75.

    The thing about statistics is that it's unfortunately all too easy to create methodologies to support any outcome you want.

    10-15% of all calories consumed by North American teenagers come from sugar sweetened drinks. It doesn't really take much of a meta-analysis to conclude that if we lost some or all of those calories that might indeed have an impact on weight.

  5. Ahhh...statistics can be used to support any outcome you want. I certainly agree with that. In fact, statistics can even be used to needlessly scare people about their food and health, such as leading people to belive that consuming red meat will increase their risk of death.

    Even when the study in question was not a clinical study and not a single person was ever examined, but rather a computer data dredge of a mail-in questionnaire from 14 years ago that was unable to find a single tenable correlation between meat consumption and premature death. Unfortunate, indeed.

  6. And then there's common sense. If you eat lots of sugar sweetened foods and beverages without an increase in physical activity, you will gain weight.

    Tax away. I'm drinking too much soda these days anyway.

  7. Yes Sara,

    Those darned teams of literally hundreds of scientists and the world's top nutritional epidemiologists must have it all wrong.

    I bet they all have shares in legume farms and so their vested interests must be in vilifying red meat.

    Same goes for the Harvard School of Public Health who call for the minimization of red meat - it's a little known fact that Harvard's endowment fund relies on short selling beef futures.