Averting obesity and type 2 diabetes in India through sugar-sweetened beverage taxation: an economic-epidemiologic modeling study

Averting obesity and type 2 diabetes in India through sugar-sweetened beverage taxation: an economic-epidemiologic modeling study

Sugar-sweetened beverage (SSB) consumption is established as a major risk factor for overweight and obesity, as well as an array of cardio-metabolic conditions, especially type 2 diabetes. The individual risk of type 2 diabetes attributable to SSB consumption remains statistically significant after adjustment for total energy consumption and body mass index (BMI).  While taxes on SSBs have been proposed in high-income countries to lower obesity and type 2 diabetes risks given limited success from other population measures and individual-level interventions, recent assessments reveal a majority of SSB sales now occur outside the US and Europe, where marketing efforts appear most focused.

This study seeks to estimate the potential health effects of such a fiscal strategy in the middle-income country of India, where there is heterogeneity in SSB consumption, patterns of substitution between SSBs and other beverages after tax increases and vast differences in chronic disease risk within the population.

Using consumption and price variations data from a nationally representative survey of 100,855 Indian households, the authors first calculate how changes in SSB price alter per capita consumption of SSBs and substitution with other beverages. They then incorporate SSB sales trends, body mass index (BMI), and diabetes incidence data stratified by age, sex, income, and urban/rural residence into a validated microsimulation of caloric consumption, glycemic load, overweight/obesity prevalence, and type 2 diabetes incidence among Indian subpopulations facing a 20% SSB excise tax.

Given current consumption and BMI distributions, the albeit some limitations, results suggest the largest relative effect would be expected among young rural men, refuting the a priori hypothesis that urban populations would be isolated beneficiaries of SSB taxation.

The study concludes that sustained SSB taxation at a high tax rate could mitigate rising obesity and type 2 diabetes in India among both urban and rural subpopulations.

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