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Globalization and Health

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Open Access 01-12-2019 | Obesity | Research

Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries

Authors: Fabrizio Ferretti, Michele Mariani

Published in: Globalization and Health | Issue 1/2019

Abstract

Background

A key component of ‘obesogenic environments’ is the ready availability of convenient, calorie-dense foods, in the form of hyper-palatable and relatively inexpensive ultra-processed products. Compelling evidence indicates that the regular consumption of soft drinks, specifically carbonated and non-carbonated sugar-sweetened beverages (SSBs), has a significant impact on the prevalence of overweight and obesity. However, to implement country-level effective prevention programmes we need to supplement this evidence with quantitative knowledge of the relationships between overweight/obesity and the main determinants of SSB consumption, notably SSB prices and consumers’ disposable income.

Method

Affordability considers the simultaneous effects of both price and disposable income on the buying decision. The purpose of this study was to investigate the effect of SSB affordability on the consumers’ purchasing behaviour and weight-related health outcomes. Our study was divided into three parts. First, we computed SSB consumption and affordability for approximately 150 countries worldwide. Second, we estimated a demand function for SSBs to assess the impact of affordability on consumption at the country level. Third, we used a multivariate regression model and country data on the prevalence of overweight and obesity to test the role of SSB affordability in the current obesity epidemic.

Results

The analysis reveals that SSB affordability: 1) showed both a large variability across countries and a clear tendency to increase substantially with the level of economic development; 2) played a key role in determining cross-country differences in the amount of soft drink consumed per capita; and 3) was significantly associated with the prevalence rates of both overweight and obesity. Specifically, we show that a 10 % increase in SSB affordability was associated, on average, with approximately 0.4 more overweight/obese adults per 100 inhabitants.

Conclusions

By controlling for the main possible confounding factors, our results clearly indicate that affordability is a major driver of purchasing behaviours and is significantly associated with the prevalence rates of both overweight and obesity. We thus suggest a fiscal approach to curb SSB consumption based on the effectiveness of ‘soda taxes’ to affect the long-term dynamic of SSB affordability.

Available only for authorised users

The British Medical Association defines SSBs as all non-alcoholic water based beverages with added sugar, including sugar-sweetened soft drinks, energy drinks, fruit drinks, sports drinks and fruit juice concentrates [18].

Asian soft drinks are traditional or national (carbonated and non-carbonated) SSBs commonly found in several Western Pacific and Southern-East Asian countries (especially, in Japan, Malaysia, Indonesia, Thailand and the Philippines), such as ready-to-drink tea, cereal-pulse or milk based specialties, and many different type of local fruit-flavoured soda [20].

By using affordability in the demand function as an interactive term, we obtained the following results:

1) Q = 43.74–11.41P + 0.0009YPC - 9398.35(P/YPC) + 3.44PW + 63.49WLS

(2.19) (0.0003) (2467.32) (3.10) (17.73)

t = − 5.20 3.34–3.81 1.11 3.58

Adj. R² = 0.68, n = 150

2) Q = 12.21–4.19P + 0.003YPC - 0.0005(P*YPC) + 1.65PW + 59.98WLS

(2.62) (0.0006) (0.0001) (2.97) (17.45)

t = − 1.60 4.61–3.38 0.56 3.44

Adj. R² = 0.66, n = 150.

Where White’s heteroskedasticity-adjusted standard errors are given parentheses. In each equation, the coefficient of the interactive term is significant at the 1% level. These results further support the use of the concept of affordability to investigate the consumption of SSBs.

It should be noted that, especially in high income countries, the major players in the beverage industry are currently trying to respond to public health concerns by replacing sugar (including high fructose corn syrup) with different types of artificial sweeteners [20]. From the perspective of public health, however, this marketing strategy could simply replace one problem with another, because of the potential harmful effects of these chemical additives on human health [60].

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Title: Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries
Authors: Fabrizio Ferretti
Michele Mariani
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Obesity
Obesity
Overweight
Published in: Globalization and Health / Issue 1/2019
Electronic ISSN: 1744-8603
DOI: https://doi.org/10.1186/s12992-019-0474-x

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Sugar-sweetened beverage affordability and the prevalence of overweight and obesity in a cross section of countries

Abstract

Background

Method

Results

Conclusions

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Springer Medicine

Abstract

Background

Method

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