The opportunity to make a broad impact on food policy is what drives both Claudia Nieto and Gabriela García, two PhD students from Mexico who are visiting scholars at UNC-Chapel Hill’s Global Food Research Program (GFRP) this year. Both Claudia and Gabriela are students at GFRP’s research partner National Institute of Public Health (INSP, Instituto Nacional de Salud Pública) in Mexico, where reducing high obesity rates among children is a priority.

Claudia, a Vital Strategies Healthy Food Policy Fellow, researches how digital food marketing affects children. She can recall how she, herself, was influenced by marketing growing up — specifically as a Hello Kitty fan. She recalls asking her mother to take her to McDonald’s so she could collect the Hello Kitty figures that came with the Happy Meal.

“I don’t think I finished the food, but I needed to get all of the figures,” says Claudia. “Marketing has the power to influence so much of children’s behavior and what they want to eat. Even children in preschool can remember logos and say the name of the brand.”

Claudia sees an opportunity to address health challenges with policy. In 2021, the Mexican government banned cartoon characters from the front of any food packages that have warning labels for high calorie, sugar, saturated fat, trans fat, or sodium content. Claudia would like to see that ban and other restrictions on marketing placement or tactics extended to include both digital marketing and an expansive time frame on television.

Currently, Mexico has minimal restrictions on advertising unhealthy foods during child-directed broadcasting (in TV and cinema). “If advertisers say that a show is not intended to reach children, they can advertise unhealthy foods or beverages, but children watch other shows like soccer matches and soap operas,” explains Claudia. “It would be good to see our research lead to a broader policy.”

Like Claudia, Gabriela recalls learning about nutrition through food choices she made growing up. In her case, she says her father frightened her out of eating unhealthy food. “I wanted the colorful cereal with the animal on the front of the box. I asked my father for it, but instead he gave me the plain cereal and a bag of sugar on the side,” says Gabriela. She laughs at the memory: “He told me, ‘If you want to die, put this entire bag of sugar on the cereal!’ Of course, he scared me, and I did not put the sugar on the cereal. When I tell my friends this story, they joke that I was born to be a nutritionist.”

Gabriela, who is a Fulbright Scholar, was grateful to find nutrition as a field to study. “I realized I could help people,” she says. She recalls helping her first patient, an elderly woman in a hospital, by giving her nutrition advice. “It was such a good feeling when she said she was feeling much better because of my recommendations.” Gabriela realized if she could help one person, she could go on to help communities and even populations.

Gabriela’s research focuses on evaluating the impact of the Mexican government’s taxes on sugary drinks and non-essential foods. She wants to find out how household purchases have changed with the taxes, implemented nearly a decade ago, and how the tax increase has affected children’s weight over time. “We’ve seen an impact, but people get accustomed to change,” says Gabriela. “The best-case scenario would be to increase the tax again, if we would like to see more change.”

Both students express excitement for their time in North Carolina and with GFRP. And, of course, for the local food scene. “I see a lot of diversity in packaged food choices at the supermarket,” says Claudia. “We have different brands in Mexico, and I like comparing nutrition information of these processed foods.”

Adds Gabriela: “I’m loving our social activities as a group. People bring food to share from their cultures. It makes sense because in the end, we’re studying food and how it impacts us.”

Gabriela and Claudia will be with GFRP through June and October, respectively.

CLAUDIA’S LATEST RESEARCH

The nature and extent of food marketing on Facebook, Instagram, and YouTube posts in Mexico, Pediatric Obesity, Mar. 2023

Unhealthy Food: The Beverage Industry’s Digital Media Campaign to Stop the Approval of the Front-of- Package Labelling System in Mexico, ESR Review, Dec. 2022

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GABRIELA’S LATEST RESEARCH

Dietary patterns are associated with obesity in Mexican schoolchildren, European Journal of Clinical Nutrition, Mar. 2020

Contribución de los alimentos a la ingesta total de energía en la dieta de los mexicanos mayores de cinco años (Contribution of food to the total energy intake in the diet of Mexicans older than five years), Salud Pública de Mexico, Feb. 2020

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AUTHORS:

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Read more about Mexico’s junk food tax and front-of-package labeling regulations.

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RESOURCES:

Why tax sugary drinks? 
Learn more in our sugary drink tax fact sheet.

View these and other taxes around the world in our sugary drink tax policy maps.

The post Sugary drink taxes based on volume vs. sugar density: Simulations comparing tax designs in Mexico find advantages to both appeared first on Global Food Research Program.

The team examined the self-reported soft-drink intake of participants in the three phases of Mexico’s Health Workers Cohort Study – a self-administered survey on health and lifestyle choices – and announced their findings May 6, 2020, in the British Medical Journal.

Shu Wen Ng, PhD, associate professor and distinguished scholar in public health nutrition at the UNC Gillings School of Global Public Health, is coauthor of the paper, “Association between tax on sugar sweetened beverages and soft drink consumption in adults in Mexico: open cohort longitudinal analysis of Health Workers Cohort Study.”

This research is based on work conducted at the National Institute of Public Health in Mexico, with the institute’s Luz María Sánchez-Romero, MD, PhD, as first author and Tonatiuh Barrientos-Gutiérrez, MD, PhD, as senior author.

“These results show that the tax is lowering the consumption of sugar-sweetened drinks among an adult cohort over the first three-years of the tax implementation,” says Ng. “In particular, it lowered the proportion of medium and high consumers of the beverages, while increasing the share of adults who were low-consumers and non-consumers.”

Based on soft-drink consumption, researchers categorized study participants in four groups: non-consumer, low consumer (less than one serving a week), medium consumer (at least one serving a week but less than one serving a day), and high consumer (at least one serving a day). Since the tax, the probability of being a non-consumer of soft drinks increased by 4.7 percentage points, and the probability of being a medium or high consumer of soft drinks decreased by 6.8 percentage points and 6.1 percentage, respectively.

Though these results reflect just one sample of the nation’s adults, they suggest that the implementation of this tax worked in the way the Mexican government intended it to – increasing the number of individuals who do not consume soft drinks while decreasing the numbers of those who do. The findings confirm the results of earlier research that showed a decline in sugary-beverage purchases in the first two years of the tax, but this is the first study to examine self-reported consumption of the beverages in Mexico.

Sugar sweetened beverages, such as soft drinks, are a main source of added sugars in the diet, which have been linked to obesity, diabetes, cardiovascular disease and hypertension, as well as to some types of cancer. Mexico’s high mortality and morbidity rates related to sugar-sweetened beverages led lawmakers to implement a tax of 1 peso per liter on all non-alcoholic drinks with added sugar to improve health outcomes starting in Jan 2014. Since then, other nations and cities around the world have followed with their own taxes in order to reduce obesity-related diseases in their communities.

These findings are particularly timely given that the severity of and mortality from infectious diseases, including COVID-19, are heightened among those with pre-existing chronic diseases, such as those related to obesity.

“We’re beginning to see the importance and impact of these taxes over time,” says Ng. “This not only adds to the literature we have on sugar-sweetened beverages, but it also provides evidence that these policies work and motivates the need to strengthen these policies for improved health outcomes and healthcare cost savings.”

As part of UNC’s Global Food Research Program at the Carolina Population Center, Ng and her team collaborate with partners across the globe to carefully evaluate food and nutrition policies and help to develop in-depth, longitudinal research on large-scale obesity prevention efforts. Ng introduced and advised on the analytical approach used for this paper.

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Barry Popkin, PhD, is a co-author on “Body weight impact of the sugar-sweetened beverages tax in Mexican children: A modeling study,” which was published in the April 2020 issue of Pediatric Obesity.

Childhood obesity is a strong predictor for obesity later in life, which can also lead to chronic illnesses such as diabetes, hypertension and heart disease. This is the first study to attempt to estimate the benefits the SSB tax may have health trajectories for children and adolescents in Mexico.

To estimate the one-year effect of the tax on body weight of children ages 5 to 17, the team implemented a dynamical model of childhood growth and obesity, re-calibrated to the Mexican population, assuming that the known reductions in SSBs purchases would reflect changes in consumption of the beverages.

Findings show that one year after the implementation of the current 10-percent tax, children and adolescents should have experienced an average reduction in body weight of 0.26 and 0.61 kg. For those who had been high consumers of SSBs, the team estimates the positive impact on body weight would be even greater, with an average body weight reduction of 0.50 kg for children and 0.87 kg for adolescents.

The team also evaluated data using higher tax rates and projected that those rates would produce even more positive health outcomes for children and adolescents.

“Taxation represents one of the most effective ways to reduce consumption of unhealthy SSB’s, which can make a meaningful impact on future excessive weight gain and significantly reduce the long-term risks of becoming obese,” says Popkin. “If the taxation revenue is used to support child and adolescent healthy eating, then the benefits of such taxes are enhanced.”

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The study, titled Changes in Sugar-Sweetened Soda Consumption, Weight, and Waist Circumference: 2-Year Cohort of Mexican Women, found those participants who decreased their soda intake by 1+ servings each week gained less weight than those who did not change their intake. Those participants who increased their intake of soda gained more weight. This study helps to show that even small reductions in sugary drink consumption can have a positive impact on weight. Read the full article here.

In the same issue, Barry Popkin authored an editorial, titled Mexican Cohort Study Predates but Predicts the Type of Body Composition Changes Expected From the Mexican Sugar-Sweetened Beverage Tax, outlining the important lessons to be learned from Stern’s article and other studies of the Mexican sugary drink tax and related health effects. Read the editorial here.

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The New York Times discusses the GFRP team research in an article from The Upshot:

Studies on the first year of the tax found that sugary beverage consumption fell substantially, with the biggest decreases among low-income Mexicans — the group at highest risk of obesity-related diseases. But industry analysts and anti-tax advocates had argued that the one-year results could just be a blip that would reverse as companies retooled their products, or as consumers adjusted to higher prices for their favorite drinks.

The new study, published online Wednesday in Health Affairs, shows that the results of such a tax may be far more long-lasting. The research, based on shopping data from a large sample of urban Mexican households, showed that the first year’s consumption declines continued during the second year. Over all, sugary drink sales fell by 5.5 percent in 2014 compared with the year before, and by 9.7 percent in 2015 — again compared with 2013. (The results are based on predicted volumes had there been no tax.) Once again, the largest reductions were among the poorest Mexicans.

An article by Reuters Health also discusses the GFRP team research:

A soda tax has continued to help reduce Mexico’s consumption of unhealthy beverages, researchers say. Purchases of sugar-sweetened beverages were down nearly 10 percent in the second year of the tax, a new study shows. “The tax is working” toward its objective, senior author Shu Wen Ng said in a phone interview.

Read the full publication in Health Affairs here, and read more about our research in Mexico here.

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Five years ago, Mexico led the world in per-capita consumption of Coca-Cola and other sugar-sweetened beverages. Now, it’s consumption rate is stagnant – even as rates in most other developing countries keep soaring. What explains this sudden shift toward health? Many say it is the result of a tax – a 10 percent excise tax on sugar sweetened beverages (SSBs). That the tax became policy owes much to the work of Barry M. Popkin, PhD, W.R. Kenan Jr. Distinguished Professor of nutrition and director of UNC’s Global Food Research Program, and to his collaboration with the Mexican National Institute of Public Health (INSP) and key nongovernmental organizations.

Read the article here, or download the article in PDF form, or download the full Carolina Public Health Magazine in PDF form.

The post The great unsweetening: Mexico’s beverage tax moves the country toward health appeared first on Global Food Research Program.

Read more about the study from the UNC Gillings School of Global Public Health release here.

Read the full article, published July 5, 2016 on PLOS Medicine here.

The post Evaluation of Mexico’s Tax on Nonessential Energy-Dense Foods shows Decline in Purchases appeared first on Global Food Research Program.

Researchers from the Instituto Nacional de Salud Pública (INSP), the University of North Carolina’s Gillings School of Global Public Health and UNC’s Carolina Population Center estimated changes in household purchases of beverages over the complete year of 2014 compared with beverage purchase trends from 2012 and 2013. The study was funded mainly by long-term support to the INSP and the University of North Carolina by Bloomberg Philanthropies along with supplementary funding from the Robert Wood Johnson Foundation.

Key findings include:

• There was a six percent average decline in purchases of taxed beverages during 2014, reaching a 12 percent reduction by December.
• The tax had the greatest impact among lower socioeconomic households, with a nine percent average decline in purchases of sugary drinks over 2014 and a 17 percent decline by December among that group.
• The purchase of untaxed beverages increased by four percent overall, primarily driven by an increase in bottled water purchases. This suggests that consumers are substituting healthier beverages in place of SSBs.

Read the full study here, or download the PDF here.

Listen to an interview with Shuwen Ng by Joel Werner from the Australian Broadcasting Corporation – about the effect of the SSB tax on Mexican households.

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The data comes from a commercial panel of consumers that contains information on purchases of beverages from households living in 53 cities with at least 50,000 residents. The model adjusts for the pre-existing downward trend of taxed beverages since 2012 and for macroeconomic variables that can affect purchases. Preliminary results show a 6 percent average decline in purchases of taxed beverages over 2014 compared to pre-tax trends. This difference accelerated over 2014 and the reduction compared to pre-tax trends reached 12% by December 2014. All socioeconomic groups reduced purchases of taxed beverages. Reductions were higher among lower socio-economic households, averaging 9% decline over 2014 compared to pre-tax trends and up to a 17% decline by Dec 2014. Results also show roughly a 4 percent increase in purchases of untaxed beverages over 2014, mainly driven by an increase in purchased bottled plain water (tap water intake is not collected).

These preliminary results show average effects in the population studied. Future research would provide estimations on subgroups (i.e. large consumers of taxed beverages) to assess differential effects.

These results are preliminary and are currently under peer-reviewed publication. The study is funded by Bloomberg Philanthropies and the Robert Wood Johnson Foundation.

The research team included M. Arantxa Colchero and Juan A. Rivera, Instituto Nacional de Salud Pública INSP and Barry M. Popkin and Shu Wen Ng, University of North Carolina.

Read media coverage in International Business Times here

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