After years of waiting, the World Health Organisation (WHO) finally took a stand on January 25 and urged governments to levy taxes on sugar-sweetened beverages to end childhood obesity. The recommendation was based on a new report commissioned by it. “The Commission believes that there is sufficient rationale to warrant the introduction of an effective tax on sugar-sweetened beverages,” the report notes.
Besides levying taxes, the WHO also recommends a host of other interventions such as increasing the amount of physical activity and improving access to health food.
The impact of taxation measures on purchasing behaviours has been well documented in the case of tobacco. However, in the case of sugar-rich drinks, the WHO acknowledged that strong evidence on the benefits is lacking but underlined that evidence will become available once countries that have been levying such taxes on unhealthy foods and sugar-laden drinks “monitor their progress”.
Hungary, France, Finland and Mexico are among the many countries that have taken to such measures. A tax of €1 for a container has been levied in France since January 2012 to combat rising obesity and raise funds. Thirty-four U.S. States and the District of Columbia have food taxes that affect sugar-sweetened drinks; 23 States levy taxes targeting these drinks.
Mexico, which has one of the highest prevalence rates for overweight and obesity in the world at over 33 per cent in the age bracket of 2-18 and around 70 per cent for adults, has demonstrated that significant reduction in consumption can be achieved through taxation. Excise tax of 1 peso per litre on sugar-sweetened drinks and ad valorem tax of 8 per cent on energy-dense foods have been in place in the country since January 1, 2014.
During the first year of taxation, a 6 per cent drop in average volume of unhealthy drinks purchased was recorded. The reduction was greatest among households that belonged to the lowest socio-economic stratum, notes a paper published in January 2016 in the journal The BMJ. An earlier study of November 2013, published in the journal BMC Public Health, also reported that an increase in the price of sugar-laden drinks was directly associated with reduced consumption in Mexico, Brazil, France, and a few States in the U.S.
While the risks of childhood obesity are greatest in lower socio-economic groups in the high-income countries, data from Brazil and Mexico, which are largely middle-income countries, confirm that levying taxes on sugar-rich drinks achieves the desired results in the target population.
The situation at home
In the case of India, at the current rate of sales of sugar-sweetened drinks, a 20 per cent increase in taxes will reduce overweight/obesity by 3 per cent (11.2 million cases) and diabetes by 1.6 per cent (4,00,000 cases) between 2014 and 2023, a January 2014 modelling study published in the journal PLOS ONE said.
One of the reasons for the WHO recommending taxation measures to rein in consumption of unhealthy food is the burgeoning number of overweight and obese children younger than five years. In 2014, 41 million children in this age group were either overweight or obese across the world.
India may be one of the biggest contributors to the global pool as obesity in people in the age group of 15-49 has increased steeply during the last few years, as the National Family Health Survey (NFHS) 2014-2015 reveals.
In 11 of the 13 States where surveys were conducted in 2005-2006 and 2014-2015, the percentage of men and women with obesity (body mass index or BMI ≥25 kg/m²) had increased sharply. Surprisingly, except in a few States such as Bihar, Meghalaya and Tripura, obesity has increased modestly among women but doubled or more than doubled in men in all the States between 2005-2006 and 2014-2015.
However, nationally accurate estimates of childhood obesity in India are not available. According to a study published in the journal The BMJ last year, prevalence of childhood obesity is between 5 and 14 per cent. The prevalence of overweight children under five years in India is less than 5 per cent, the WHO notes; this will still be big in absolute numbers.
A comprehensive national nutrition survey to be undertaken by UNICEF from March this year will cover children in the age group of 0-19 across all 29 States. This will provide the much-needed data that can guide the government in framing policy guidelines. Meanwhile, all stakeholders need to use the growth charts revised last year by the Indian Academy of Paediatrics for 5- to 18-year-old children to define overweight and obesity (BMI of 23 and 27 respectively).
India faces a double whammy of obesity and underweight/wasted children. Though with respect to the last NHFS survey the percentage of underweight children has reduced this time, it is still very high — from nearly 14 per cent in Sikkim to nearly 44 per cent in Bihar. This is a big concern as children who were born with low birth weight are at a greater risk of becoming overweight and obese when they consume energy-rich diets and have a sedentary lifestyle.
This singularly must be the reason why India should seriously consider introducing additional taxes on sugar-laden dinks, besides encouraging more physical activity in schools and other interventions.