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 Table of Contents  
PERSPECTIVE
Year : 2017  |  Volume : 2  |  Issue : 2  |  Page : 56-59

Sugar and fat taxes as means to halt obesity and prevent lifestyle diseases: Opportunities and challenges in the Indian context


1 Department of Community Medicine, Maulana Azad Medical College, New Delhi, India
2 Department of Community Medicine, Lady Hardinge Medical College, New Delhi, India

Date of Web Publication18-Jul-2017

Correspondence Address:
Saurav Basu
Department of Community Medicine, Maulana Azad Medical College, New Delhi
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jncd.jncd_15_17

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  Abstract 

Obesity in both children and adults is a major public health problem globally and is also increasing in the developing world which contributes to the epidemic of early onset of non-communicable diseases and associated premature mortality. Dietary consumption of unhealthy foods rich in sugar, salt and saturated fats is a significant risk factor for obesity. There is growing evidence that taxation on sugar sweetened beverages (SSBs) and fat rich foods along with restricting access to such unhealthy foods in school premises can shift dietary consumption patterns of school students towards healthier foods and reduce their risk of developing obesity and lifestyle diseases. However, despite some limited initiatives, the application of taxes on SSBs as a public health intervention have yet to be unequivocally applied in Indian settings due to inadequate advocacy from public health groups and political reluctance due to the industry being a major source of tax revenue. Efforts in combating obesity through tax on unhealthy foods like SSBs and fats is overdue in India but the barriers and challenges against their successful implementation cannot be overlooked. These include the necessity of application of a sufficiently high tax which would compel manufacturers of unhealthy foods like SSBs to pass the burden of the tax upon consumers by significantly increase retail prices. Furthermore, India's vast informal food sector producing local counterparts of branded SSB and fat foods should not be spared and kept out of the taxation net out of any political considerations. Similarly, the restriction on sale of unhealthy foods in school premises should also include implementation in areas and markets in the vicinity to which students have easy access.

Keywords: India, obesity, sugar, taxes


How to cite this article:
Basu S, Dahiya N, Bachani D. Sugar and fat taxes as means to halt obesity and prevent lifestyle diseases: Opportunities and challenges in the Indian context. Int J Non-Commun Dis 2017;2:56-9

How to cite this URL:
Basu S, Dahiya N, Bachani D. Sugar and fat taxes as means to halt obesity and prevent lifestyle diseases: Opportunities and challenges in the Indian context. Int J Non-Commun Dis [serial online] 2017 [cited 2019 Mar 23];2:56-9. Available from: http://www.ijncd.org/text.asp?2017/2/2/56/211074


  Introduction Top


Obesity is a major public health problem with an estimated 600 million and 1.9 billion adults globally being overweight and obese, respectively.[1] Obesity is associated with increased risk of development of noncommunicable diseases including diabetes mellitus (DM) and cardiovascular disease. The prevalence of childhood obesity is also increasing at an alarming pace, especially in urban regions of low- and middle-income countries.[2] A major risk factor for obesity in the developing world is an ongoing nutritional transition which is increasing the consumption of processed foods rich in saturated fat, salt, and sugar.[3],[4]

The increase in obesity has been estimated to be capable of propagating the diabetes epidemic in low- and middle-income countries as an independent risk factor until 2030 which signifies the enormous health and economic losses if current trends in obesity persist.[5] Measures to stop the obesity epidemic through traditional approaches including Information, Education, and Communication and Behavior Change Communication counseling for promoting healthy food consumption and discouraging intake of unhealthy food rich in fat and sugars have proven to be inadequate.[6] Other approaches promoting healthy lifestyles and regular physical activity are limited by the undesirable living environments often lacking sufficient recreational spaces in low-income unplanned urban regions which are ubiquitous in large parts of the developing countries.[7],[8] Newer approaches to controlling obesity and ending childhood obesity have focused on the reduction of intake of sugar-sweetened beverages (SSBs) and saturated fats in at-risk populations such as school-going children. The consumption of SSBs which contain no nutritional value except empty calories is linked with adverse health outcomes such as obesity, cardiovascular risks, DM, and dental caries although causal linkages are yet unproven.[9],[10],[11],[12],[13]


  Newer Public Health Interventions to Combat Obesity Top


Public health policies concentrating upon reducing SSB and fat consumption have prioritized the following approaches:

  1. Application of significant excess taxation upon SSB and fat-rich food manufacturers to increase retail cost of SSBs expected to negatively influence consumer behavior and reduce their sale and consumption. Furthermore, the state is expected to gain excess tax revenues which can be utilized for promoting public health
  2. Restricting the sale of SSB and fat-rich products in school and their neighboring areas to reduce accessibility and availability of such unhealthy foods which should decrease their consumption. Furthermore, a switch toward healthier alternatives such as safe, potable drinking water, and healthy foods should be encouraged by increasing their availability and affordability.



  Sugar-Fat Taxes to Control Obesity in India: Opportunities and Challenges Top


In India, few such measures have been undertaken to restrict access to unhealthy foods. The state of Kerala was the first to impose a 14.5% tax on “junk food” (food rich in saturated fat, salt, and sugar) sold by organized fast food chain outlets in 2016.[14] The Government of India is considering imposition of a 40% tax upon SSB manufacturers, especially those producing carbonated drinks.[15] The High Court of Delhi in an order had curbed the sale of such foods within a 50 m vicinity of all schools of India in 2015.[16] The application of sugar and fat taxes to improve the health of Indian populations, therefore, represents an untested opportunity but is also prone to threats which are considered below:

  1. There is growing evidence that fat and SSB taxation, in particular, is an effective method for reducing the burden of obesity and chronic disease.[17] The Centre for Disease Control, USA, has recommended differential pricing as a strategy for reducing consumption of SSBs and promoting healthier alternatives.[18] Nakhimovsky et al. through a systematic review of the evidence have reported that even countries with relatively lower baseline per capita SSB consumption like India could reduce net energy intake in their populations through sufficiently high taxations of SSB products.[19] Mexico introduced a 10% soda tax which helped it successfully reduce their demand and consumption.[20] An excise tax on SSBs in Berkeley, California, increased retail SSB prices compared to neighboring cities within 3 months of its application.[21] Furthermore, demand for SSB is elastic suggesting that as increase in SSB prices by 7%–10% should decrease demand by approximately the same amount.[22] The study by Ford et al. among US households with preschool children suggested that simulated price increases of 10%, 15%, and 20% on SSBs were associated with fewer purchases of juice drinks[23]


  2. Based on current evidence, the time is right to impose SSB taxation in India

  3. In capitalist economies committed to free market and libertarian ideals as in the USA, selective imposition of taxation upon SSB manufacturers has invariably involved enormous legal resistance which has resulted in several bills for the imposition of excise taxes upon SSBs being introduced without passage in several US states.[24] In contrast, in India, no significant legal impediment toward imposition of measures for promoting public health is expected judicially. Instead, it is the legislature and their collective political which is susceptible to threats of decreased revenues and resulting unemployment from shrinking SSB industries. Furthermore, health being a state subject in India, political dynamics would determine the universal adoption of taxation upon SSB industry. States which have significant revenue generation from SSB consumption could be disinclined to impose excess taxation compared to states with low per capita consumption. Nevertheless, with the Goods and Services Tax being passed for implementation, states may not have much autonomy on this issue
  4. Selective application of taxes upon some branded SSB and “junk food” industries may be initiated in the initial phases. However, unhealthy foods produced by the local, informal food sector should not be spared from taxation out of political considerations stemming from the large size of the informal food sector in India which provides employment to millions of people.[25] Moreover, the presence of unhealthy fat and bacterial contamination have been reported in studies examining street food samples, especially in low socioeconomic areas of India.[25],[26] Sparing the informal food sector from taxes may encourage consumers to shift consumption from “branded” to “local” unhealthy food products


  5. Furthermore, the imposed tax has to be sufficiently high to compel SSB companies to raise retail prices and pass them upon consumers

  6. Restricting access of school-going children to SSBs and “junk food” by banning sale of such unhealthy foods within school premises has been effective in the US schools where soda vending machines were removed.[27] In the Indian context, the feasibility of application of such measures in smaller government- and municipality-run schools may be challenging since consumption of such items may often occur just outside the school premises on the streets which are occupied by hawkers out to make a living. Thus, the restrictions should be applied not only in schools but also in areas/markets close to schools
  7. Studies to assess public opinion on SSB taxes and the knowledge, attitude, and practices relating to consumption of SSBs and junk foods in vulnerable populations are required so that appropriate interventions to increase awareness of long-term harmful effects of SSBs in those at risk can be carried out. Furthermore, effective health communication explaining government actions promoting healthy food options and discouraging SSB and junk foods should accompany imposition of such measures. Finally, SSB taxation has the risk of becoming a populist measure in the absence of accompanying rigorous research and evaluation of its effect in reducing SSB consumption and estimating the long-term impact on the prevalence of DM and chronic diseases in the community.


Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
WHO. Obesity and Overweight Factsheet. Available from: http://www.who.int/mediacentre/factsheets/fs311/en/. [Last cited on 2017 Mar 02].  Back to cited text no. 1
    
2.
WHO. Childhood Obesity Factsheet. Available from: http://www.who.int/dietphysicalactivity/childhood/en/. [Last cited on 2017 Mar 02].  Back to cited text no. 2
    
3.
Hu FB. Globalization of diabetes: The role of diet, lifestyle, and genes. Diabetes Care 2011;34:1249-57.  Back to cited text no. 3
    
4.
Shetty PS. Nutrition transition in India. Public Health Nutr 2002;5:175-82.  Back to cited text no. 4
    
5.
Wild S, Roglic G, Green A, Sicree R, King H. Global prevalence of diabetes: Estimates for the year 2000 and projections for 2030. Diabetes Care 2004;27:1047-53.  Back to cited text no. 5
    
6.
Wake M, Baur LA, Gerner B, Gibbons K, Gold L, Gunn J, et al. Outcomes and costs of primary care surveillance and intervention for overweight or obese children: The LEAP 2 randomised controlled trial. BMJ 2009;339:b3308.  Back to cited text no. 6
    
7.
Cohen DA, McKenzie TL, Sehgal A, Williamson S, Golinelli D, Lurie N. Contribution of public parks to physical activity. Am J Public Health 2007;97:509-14.  Back to cited text no. 7
    
8.
Diez Roux AV, Evenson KR, McGinn AP, Brown DG, Moore L, Brines S, et al. Availability of recreational resources and physical activity in adults. Am J Public Health 2007;97:493-9.  Back to cited text no. 8
    
9.
Vartanian LR, Schwartz MB, Brownell KD. Effects of soft drink consumption on nutrition and health: A systematic review and meta-analysis. Am J Public Health 2007;97:667-75.  Back to cited text no. 9
    
10.
Malik VS, Popkin BM, Bray GA, Després JP, Hu FB. Sugar-sweetened beverages, obesity, type 2 diabetes mellitus, and cardiovascular disease risk. Circulation 2010;121:1356-64.  Back to cited text no. 10
    
11.
Scientific Advisory Committee on Nutrition. Carbohydrates and Health; July, 2015. Available from: https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/445503/SACN_Carbohydrates_and_Health.pdf. [Last cited on 2017 Mar 02].  Back to cited text no. 11
    
12.
Hu FB. Resolved: There is sufficient scientific evidence that decreasing sugar-sweetened beverage consumption will reduce the prevalence of obesity and obesity-related diseases. Obes Rev 2013;14:606-19.  Back to cited text no. 12
    
13.
Kaiser KA, Shikany JM, Keating KD, Allison DB. Will reducing sugar-sweetened beverage consumption reduce obesity? Evidence supporting conjecture is strong, but evidence when testing effect is weak. Obes Rev 2013;14:620-33.  Back to cited text no. 13
    
14.
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16.
Times of India. Available from: http://www.timesofindia.indiatimes.com/city/delhi/Junk-food-curbed-not-banned-in-schools/articleshow/46602789.cms. [Last accessed on 2017 Jun 18].  Back to cited text no. 16
    
17.
Encarnação R, Lloyd-Williams F, Bromley H, Capewell S. Obesity prevention strategies: Could food or soda taxes improve health? J R Coll Physicians Edinb 2016;46:32-8.  Back to cited text no. 17
    
18.
The CDC Guide to Strategies for Reducing the Consumption of Sugar-Sweetened Beverages. Available from: http://www.cdph.ca.gov/SiteCollectionDocuments/StratstoReduce_Sugar_Sweetened_Bevs.pdf. [Last accessed on 2017 Jun 18].  Back to cited text no. 18
    
19.
Nakhimovsky SS, Feigl AB, Avila C, O'Sullivan G, Macgregor-Skinner E, Spranca M. Taxes on sugar-sweetened beverages to reduce overweight and obesity in middle-income countries: A systematic review. PLoS One 2016;11:e0163358.  Back to cited text no. 19
    
20.
Colchero MA, Popkin BM, Rivera JA, Ng SW. Beverage purchases from stores in Mexico under the excise tax on sugar sweetened beverages: Observational study. BMJ 2016;352:h6704.  Back to cited text no. 20
    
21.
Falbe J, Rojas N, Grummon AH, Madsen KA. Higher retail prices of sugar-sweetened beverages 3 months after implementation of an excise tax in Berkeley, California. Am J Public Health 2015;105:2194-201.  Back to cited text no. 21
    
22.
Friedman RR. A Soda Tax, Will it Change Anything? Tampa, FL: Obesity Action Coalition. Available from: http://www.obesityaction.org/educational-resources/resource-articles-2/nutrition/a-soda-tax-will-it-change-anything. [Last accessed on 2017 Jun 18].  Back to cited text no. 22
    
23.
Ford CN, Ng SW, Popkin BM. Targeted beverage taxes influence food and beverage purchases among households with preschool children. J Nutr 2015;145:1835-43.  Back to cited text no. 23
    
24.
Gollust SE, Tang X, White JM, French SA, Runge CF, Rothman AJ. Young adults' responses to alternative messages describing a sugar-sweetened beverage price increase. Public Health Nutr 2017;20:46-52.  Back to cited text no. 24
    
25.
Food and Agriculture Organization of the United Nations (FAO). Promises and Challenges in the Informal Food Sector in the Developing Countries: Rome; 2007. Available from: http://www.fao.org/docrep/010/a1124e/a1124e00.htm. [Last cited on 2017 Mar 02].  Back to cited text no. 25
    
26.
Gupta V, Downs SM, Ghosh-Jerath S, Lock K, Singh A. Unhealthy fat in street and snack foods in low-socioeconomic settings in India: A case study of the food environments of rural villages and an Urban Slum. J Nutr Educ Behav 2016;48:269-79.e1.  Back to cited text no. 26
    
27.
Taber DR, Chriqui JF, Vuillaume R, Kelder SH, Chaloupka FJ. Is it Enough to Just Ban Soda From Schools to Reduce Consumption of Sugar-Sweetened Beverages? A BTG Research Brief. Chicago, IL: Bridging the Gap Program, Health Policy Center, Institute for Health Research and Policy, University of Illinois at Chicago; 2015.  Back to cited text no. 27
    




 

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