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Ferreira SRG, Macotela Y, Velloso LA, Mori MA. Determinants of obesity in Latin America. Nat Metab 2024; 6:409-432. [PMID: 38438626 DOI: 10.1038/s42255-024-00977-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 01/04/2024] [Indexed: 03/06/2024]
Abstract
Obesity rates are increasing almost everywhere in the world, although the pace and timing for this increase differ when populations from developed and developing countries are compared. The sharp and more recent increase in obesity rates in many Latin American countries is an example of that and results from regional characteristics that emerge from interactions between multiple factors. Aware of the complexity of enumerating these factors, we highlight eight main determinants (the physical environment, food exposure, economic and political interest, social inequity, limited access to scientific knowledge, culture, contextual behaviour and genetics) and discuss how they impact obesity rates in Latin American countries. We propose that initiatives aimed at understanding obesity and hampering obesity growth in Latin America should involve multidisciplinary, global approaches that consider these determinants to build more effective public policy and strategies, accounting for regional differences and disease complexity at the individual and systemic levels.
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Affiliation(s)
| | - Yazmín Macotela
- Instituto de Neurobiología, Universidad Nacional Autónoma de México, UNAM Campus-Juriquilla, Querétaro, Mexico
| | - Licio A Velloso
- Obesity and Comorbidities Research Center, Faculty of Medical Sciences, Universidade Estadual de Campinas, Campinas, Brazil
| | - Marcelo A Mori
- Institute of Biology, Universidade Estadual de Campinas, Campinas, Brazil.
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2
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Lutter CK. Improvement of the Brazilian nutritional scenario despite the persistence of social inequalities. CAD SAUDE PUBLICA 2023; 39:e00136323. [PMID: 37878869 PMCID: PMC10599223 DOI: 10.1590/0102-311xen136323] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 10/27/2023] Open
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Gustafson CR. Evaluating the relative impact of multiple healthy food choice interventions on choice process variables and choices. Appetite 2023; 187:106596. [PMID: 37169259 DOI: 10.1016/j.appet.2023.106596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Revised: 04/26/2023] [Accepted: 05/08/2023] [Indexed: 05/13/2023]
Abstract
Fiscal tools-taxes and/or subsidies-are increasingly used to address diet-related health problems. However, some studies have found that these tools are markedly more effective if attention is drawn to the tax or subsidy, suggesting that the price change alone may go unnoticed in the complex food environments that consumers face. Interventions that prompt individuals to consider health during choice show promise for promoting healthy food choices in both simple laboratory settings and complex, real-world markets. In this pre-registered study, I examine the impact of dietary fiber health prompts and/or dietary fiber subsidies on the per-serving fiber content of foods chosen, the documented set of products considered, and (self-reported) nutrition information use by participants in an online supermarket setting. Participants were randomized to one of four conditions: 1) control, 2) subsidy, 3) fiber prompt, and 4) fiber prompt + subsidy. Results show that both the prompt and prompt + subsidy conditions significantly increase fiber content of foods chosen (with the latter having a larger effect). While all three interventions influence the probability of using nutrition information during food choice and affect the set of products that respondents consider relative to the control condition, the effects were larger for the prompt and prompt + subsidy conditions. A multiple mediation analysis illustrates that both direct and indirect (through the set of products considered and the use of fiber information during choice) pathways lead to the significant overall increase in fiber content of selected foods.
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Affiliation(s)
- Christopher R Gustafson
- Department of Agricultural Economics, University of Nebraska-Lincoln 314A Filley Hall, Lincoln, NE, 68583, USA.
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Prescott SL, D’Adamo CR, Holton KF, Ortiz S, Overby N, Logan AC. Beyond Plants: The Ultra-Processing of Global Diets Is Harming the Health of People, Places, and Planet. Int J Environ Res Public Health 2023; 20:6461. [PMID: 37569002 PMCID: PMC10419141 DOI: 10.3390/ijerph20156461] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 07/20/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023]
Abstract
Global food systems are a central issue for personal and planetary health in the Anthropocene. One aspect of major concern is the dramatic global spread of ultra-processed convenience foods in the last 75 years, which is linked with the rising human burden of disease and growing sustainability and environmental health challenges. However, there are also calls to radically transform global food systems, from animal to plant-derived protein sources, which may have unintended consequences. Commercial entities have moved toward this "great plant transition" with vigor. Whether motivated by profit or genuine environmental concern, this effort has facilitated the emergence of novel ultra-processed "plant-based" commercial products devoid of nutrients and fiber, and sometimes inclusive of high sugar, industrial fats, and synthetic additives. These and other ingredients combined into "plant-based" foods are often assumed to be healthy and lower in calorie content. However, the available evidence indicates that many of these products can potentially compromise health at all scales-of people, places, and planet. In this viewpoint, we summarize and reflect on the evidence and discussions presented at the Nova Network planetary health meeting on the "Future of Food", which had a particular focus on the encroachment of ultra-processed foods into the global food supply, including the plant-sourced animal protein alternatives (and the collective of ingredients therein) that are finding their way into global fast-food chains. We contend that while there has been much uncritical media attention given to the environmental impact of protein and macronutrient sources-meat vs. novel soy/pea protein burgers, etc.-the impact of the heavy industrial processing on both human and environmental health is significant but often overlooked, including effects on cognition and mental health. This calls for a more nuanced discourse that considers these complexities and refocuses priorities and value systems towards mutualistic solutions, with co-benefits for individuals, local communities, and global ecology.
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Affiliation(s)
- Susan L. Prescott
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
- Medical School, University of Western Australia, Nedlands, WA 6009, Australia
- The ORIGINS Project, Telethon Kids Institute, Nedlands, WA 6009, Australia
| | - Christopher R. D’Adamo
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
- Department of Family and Community Medicine, University of Maryland School of Medicine, Baltimore, MD 21201, USA
| | - Kathleen F. Holton
- Departments of Health Studies and Neuroscience, Center for Neuroscience and Behavior, American University, Washington, DC 20016, USA;
| | - Selena Ortiz
- Department of Health Policy and Administration, The Pennsylvania State University, State College, PA 16802, USA;
| | - Nina Overby
- Department of Nutrition and Public Health, Centre for Lifecourse Nutrition, University of Agder, 4630 Kristiansand, Norway;
| | - Alan C. Logan
- Nova Institute for Health, Baltimore, MD 21231, USA; (C.R.D.); (A.C.L.)
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5
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Batis C, Castellanos-Gutiérrez A, Sánchez-Pimienta TG, Reyes-García A, Colchero MA, Basto-Abreu A, Barrientos-Gutiérrez T, Rivera JA. Comparison of Dietary Intake Before vs After Taxes on Sugar-Sweetened Beverages and Nonessential Energy-Dense Foods in Mexico, 2012 to 2018. JAMA Netw Open 2023; 6:e2325191. [PMID: 37486629 PMCID: PMC10366703 DOI: 10.1001/jamanetworkopen.2023.25191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/25/2023] Open
Abstract
Importance Tax evaluations have shown effectiveness in reducing purchases of taxed items. However, few studies have looked at changes in overall dietary intake according to national surveys. Objective To estimate the contribution of taxed and untaxed beverages and foods to dietary intake over time, and the nutritional dietary profile in total beverages and foods consumed. Design, Setting, and Participants This cross-sectional study used data from 3 National Health and Nutrition Surveys of a nationally representative sample of participants aged older than 1 year in Mexico from 2012 (pretax), 2016, and 2018 (posttax). Data were analyzed from September 2021 to December 2022. Exposure Taxes on sugar-sweetened beverages and nonessential energy-dense foods implemented since 2014. Main Outcomes and Measures The outcomes were the contribution of taxed and untaxed beverages to total beverage volume, the contribution of taxed and untaxed foods to total food energy, and the energy density and content of added sugars and saturated fats. Outcomes were assessed with 24-hour recalls (24HR) (2012 and 2016) and Food Frequency Questionnaires (FFQ) (2012, 2016, and 2018), and were adjusted by sociodemographic and macroeconomic variables. Results A total of 17 239 participants were analyzed from 2012, 18 974 from 2016, and 30 027 from 2018; approximately 50% were men, and approximately 75% lived in urban areas. According to 24HRs, the contribution of taxed beverages to total beverage volume changed -2.3 (95% CI, -4.4 to -0.2) percentage points from 2012 to 2016, while water increased. The contribution of taxed foods to total food energy changed -3.0 (95% CI, -4.2 to -1.8) percentage points, while untaxed whole grains, processed meats, other animal sources, and sugars and desserts increased. The content in total beverages of added sugars changed -1.1 kcal/100 mL (95% CI, -2.0 to -0.2), and in total foods, the content of added sugar changed -0.6 %kcal (95% CI, -1.0 to -0.2), saturated fat changed -0.8 %kcal (95% CI, -1.1 to -0.4), and energy density changed -9.8 kcal/100 g (95% CI, -13.8 to -5.8). Main results were consistent with the FFQ (up to 2018), with some differences in subgroups and nutritional components. Conclusions and Relevance The findings of this study on 3 cross-sectional national dietary surveys are consistent with previous evaluations; after tax implementation, there was a decrease in the contribution of taxed items. Furthermore, some unhealthy untaxed items increased, but the content of unhealthful nutritional components, particularly added sugar, in overall beverages and foods decreased.
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Affiliation(s)
- Carolina Batis
- Consejo Nacional de Ciencia y Tecnología-Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Analí Castellanos-Gutiérrez
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
- Harvard T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Tania G Sánchez-Pimienta
- Center for Health and Nutrition Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Alan Reyes-García
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - M Arantxa Colchero
- Center for Health Systems Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Ana Basto-Abreu
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | | | - Juan A Rivera
- Center for Population Health Research, National Institute of Public Health, Cuernavaca, Mexico
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Melo G, Aguilar-Farias N, López Barrera E, Chomalí L, Moz-Christofoletti MA, Salgado JC, Swensson LJ, Caro JC. Structural responses to the obesity epidemic in Latin America: what are the next steps for food and physical activity policies? Lancet Reg Health Am 2023; 21:100486. [PMID: 37096192 PMCID: PMC10122054 DOI: 10.1016/j.lana.2023.100486] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 02/12/2023] [Accepted: 03/20/2023] [Indexed: 04/26/2023]
Abstract
Obesity is among the most complex public health challenges, particularly in Latin America, where obesity rates have increased faster than in any other region. Many countries have proposed or enacted comprehensive policies to promote adequate diet and physical activity under a structural framework. We summarize articles discussing the scope and impact of recently implemented obesity-related interventions in the light of a structural response framework. Overall, we find that: (1) market-based food interventions, including taxes on junk food, nutrition labelling, and marketing restrictions, decrease the consumption of targeted foods, (2) programs directly providing healthy foods are effective in reducing obesity, and (3) the construction of public areas for recreation increases the average frequency of physical activity. Although obesity-related interventions in the region have somewhat improved health behaviours, obesity prevalence remains on an upward trend. We discuss some opportunities to continue tackling the obesity epidemic in LATAM under a structural framework.
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Affiliation(s)
- Grace Melo
- Accountability, Climate, Equity, and Scholarship (ACES), Department of Agricultural Economics, Texas A&M, College Station, TX, USA
| | - Nicolas Aguilar-Farias
- Department of Physical Education, Sports and Recreation, Universidad de la Frontera, Chile
| | | | | | | | - Juan Carlos Salgado
- Center for Nutrition and Health Research, National Institute of Public Health and National Council for Science and Technology, Mexico
| | - Luana Joppert Swensson
- Policy and Legal Specialist for Sustainable Public Procurement, Food and Agriculture Organization, Italy
| | - Juan Carlos Caro
- Department of Industrial Engineering, University of Concepción, Chile
- Corresponding author. Department of Industrial Engineering, University of Concepción, Chile, Edmundo Larenas 219, Concepción, Chile.
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Eddie R, Curley C, Yazzie D, Francisco S, Antone-Nez R, Begay GA, Sanderson PR, George C, Shin S, Jumbo-Rintila S, Teufel-Shone N, Baldwin J, de Heer H“D. Practicing Tribal Sovereignty Through a Tribal Health Policy: Implementation of the Healthy Diné Nation Act on the Navajo Nation. Prev Chronic Dis 2022; 19:E78. [PMID: 36417292 PMCID: PMC9717698 DOI: 10.5888/pcd19.220106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION The Navajo Nation is a large sovereign tribal nation. After several years of grassroots efforts and overcoming an initial presidential veto, the Navajo Nation passed the Healthy Diné Nation Act (HDNA) in 2014 to promote healthy behaviors in Navajo communities. This was the first such policy in the US and in any sovereign tribal nation worldwide. PURPOSE AND OBJECTIVES The objective of this study was to describe the process, implementation, and evaluation of the HDNA passage and its 2020 reauthorization and the potential for using existing and tribal-specific data to inform tribal policy making. INTERVENTION APPROACH The HDNA included a 2% tax on unhealthy foods sold on the Navajo Nation and waived a 6% sales tax on healthy foods. HDNA-generated funds were allocated to 110 local communities for wellness projects. No funds were allocated for enforcement or compliance. EVALUATION METHODS We assessed HDNA tax revenue and tax-funded wellness projects in 110 chapters over time, by region and community size. The food store environment was assessed for fidelity of HDNA implementation, price changes since pretax levels, and shopper behaviors. HDNA revenue was cross-matched with baseline nutrition behaviors and health status through a Navajo-specific Behavioral Risk Factor Surveillance System survey. RESULTS HDNA revenue decreased modestly annually, and 99% of revenue was disbursed to local chapters, mostly for the built recreational environment, education, equipment, and social events. Stores implemented the 2% tax accurately, and the food store environment improved modestly. Regions with high tax revenue also had high rates of diabetes, but not other chronic conditions. The HDNA was reauthorized in 2020. IMPLICATIONS FOR PUBLIC HEALTH Sovereign tribal nations can drive their own health policy. Program evaluation can use existing data sources, tailored data collection efforts, and tribal-specific surveys to gain insight into feasibility, implementation, and impact.
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Affiliation(s)
- Regina Eddie
- School of Nursing, Northern Arizona University, Flagstaff, Arizona
| | - Caleigh Curley
- Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona,Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, Arizona
| | - Del Yazzie
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona
| | - Simental Francisco
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona
| | - Ramona Antone-Nez
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona
| | | | | | | | - Sonya Shin
- Brigham and Women’s Hospital, Boston, Massachusetts
| | | | | | - Julie Baldwin
- Department of Health Sciences, Northern Arizona University, Flagstaff, Arizona
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8
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Romero Ferreiro C, Cancelas Navia P, Lora Pablos D, Gómez de la Cámara A. Geographical and Temporal Variability of Ultra-Processed Food Consumption in the Spanish Population: Findings from the DRECE Study. Nutrients 2022; 14. [PMID: 35956398 DOI: 10.3390/nu14153223] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Revised: 08/01/2022] [Accepted: 08/03/2022] [Indexed: 11/16/2022] Open
Abstract
The consumption of ultra-processed foods (UPFs) has increased in recent decades, worldwide. Evidence on the negative impacts of food processing on health outcomes has also been steadily increasing. The aim of this study is to describe changes in consumption patterns of ultra-processed foods in the Spanish population over time and their geographical variability. Data from four representative cohorts of the Spanish population were used (1991−1996−2004−2008). Dietary information was collected using a validated frequency questionnaire and categorized using the NOVA classification. A total increase of 10.8% in UPF consumption between 1991 and 2008 was found in Spain (p-value < 0.001). The products contributing most to UPF consumption were sugar-sweetened beverages, processed meats, dairy products, and sweets. Those who consumed more ultra-processed foods were younger (p-value < 0.001) and female (p-value = 0.01). Significant differences between the different geographical areas of Spain were found. The eastern part of Spain was the area with the lowest UPF consumption, whereas the north-western part was the area with the highest increase in UPF consumption. Given the negative effect that the consumption of ultra-processed foods has on health, it is necessary to implement public health policies to curb this increase in UPF consumption.
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Molina M, Anderson LN, Guindon GE, Tarride JE. A review of implementation and evaluation of Pan American Health Organization's policies to prevent childhood obesity in Latin America. Obes Sci Pract 2022; 8:352-362. [PMID: 35664241 PMCID: PMC9159564 DOI: 10.1002/osp4.572] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 10/12/2021] [Accepted: 10/13/2021] [Indexed: 12/17/2022] Open
Abstract
Rationale To inform future policies, the study objectives were to determine to what extent the policies included in the 5‐year Plan of Action for the Prevention of Obesity in Children and Adolescents—proposed by Pan American Health Organization (PAHO) and signed by 19 Latin America countries in 2014—have been implemented and evaluated. Methods A scoping review of the Governmental websites for Latin American countries and a literature review was conducted to identify whether policies have been implemented and evaluated. Key information was abstracted. Results The review identified 115 PAHO policies/interventions implemented (43% implemented after signing the proposed plan in 2014). Nearly all (18/19) countries implemented food guidelines or school feeding programs, but fiscal and marketing policies were less commonly implemented (6/19). Through the review, 44 evaluations of PAHO policies were identified of which 23% were qualitative and 77% quantitative. The results of these evaluations were in general positive (e.g., decrease in sugar‐sweetened beverages consumption following tax implementation) but no studies evaluated the outcome of reduced obesity. Conclusions PAHO recommended policies have been implemented to various degrees in Latin America since 2014 and more research is required to understand their impacts on child and adolescent obesity.
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Affiliation(s)
- Mariana Molina
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada
| | - Laura N Anderson
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada.,Centre for Health Economics and Policy Analysis McMaster University Hamilton Ontario Canada.,The Hospital for Sick Children Research Institute Child Health Evaluative Sciences Toronto Ontario Canada
| | - Godefroy E Guindon
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada.,Centre for Health Economics and Policy Analysis McMaster University Hamilton Ontario Canada.,Department of Economics McMaster University Hamilton Ontario Canada
| | - Jean-Eric Tarride
- Department of Health Research Methods, Evidence, and Impact McMaster University Hamilton Ontario Canada.,Centre for Health Economics and Policy Analysis McMaster University Hamilton Ontario Canada.,The Research Institute of St. Joe's Hamilton St. Joseph's Healthcare Hamilton Hamilton Ontario Canada.,McMaster Chair in Health Technology Management Hamilton Hamilton Ontario Canada
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10
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Trujillo Lalla A, George C, Bancroft C, Edison T, Ricks A, Tabb K, Sandman S, Salt SK, Curley C, de Heer H“D, Curley CA, Yazzie D, Shin SS. Shopper Purchasing Trends at Small Stores on the Navajo Nation since the Passage of the Healthy Diné Nation Act Tax: A Multi-Year Cross-sectional Survey. Curr Dev Nutr 2022; 6:nzac040. [PMID: 35592518 PMCID: PMC9113337 DOI: 10.1093/cdn/nzac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 11/01/2021] [Accepted: 03/17/2022] [Indexed: 12/03/2022] Open
Abstract
Background In 2014, the Navajo Nation passed the Healthy Diné Nation Act (HDNA), which applies an additional 2% tax on unhealthy foods and beverages and a waiver of Navajo sales tax on healthy foods and beverages. However, the HDNA's impact on purchasing behavior has not been explored. Objectives We assessed beverage and produce purchasing trends among shoppers at small Navajo stores between 2017 and 2019, shopper characteristics associated with buying water, and whether HDNA awareness was associated with purchasing behaviors. Methods A total of 332 shoppers at 34 stores in 2017 and 274 shoppers at 44 stores in 2019 were surveyed to assess HDNA awareness and same-day purchasing of water, sugar-sweetened beverages (SSBs), fruits, and vegetables. Hypotheses were tested using chi-square analyses and multivariate analysis. Results Water purchasing among respondents increased significantly from 2017 to 2019 (24.4% to 32.8%; P = 0.03). Shoppers in 2019 were 1.5 times more likely to purchase water compared with 2017 (adjusted P = 0.01). There was a trend toward reduced SSB purchasing (85.8% in 2017, 80.3% in 2019, P = 0.068), while produce purchasing remained unchanged over time, at approximately 17%. Shoppers were more likely to buy water if they relied on that store for the majority of their groceries (P = 0.006) and if they did not have their own transportation to get to the store (P = 0.004). Most shoppers (56.6%) were aware of the HDNA; of these, 35.6% attributed healthier habits to the HDNA, most commonly buying more healthy drinks (49.2%), fewer unhealthy drinks (37.7%), more healthy snacks (31.1%), and fewer unhealthy snacks (26.2%). Conclusions Shopper habits at small stores located on the Navajo Nation have shifted towards healthier purchasing from 2017 to 2019. Shoppers who were aware of the HDNA reported purchasing more healthy and fewer unhealthy food and drinks as a result of this legislation.
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Affiliation(s)
- Amber Trujillo Lalla
- University of New Mexico School of Medicine, Albuquerque, NM, USA
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
| | - Carmen George
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | - Carolyn Bancroft
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Tierra Edison
- Community Outreach and Patient Empowerment, Gallup, NM, USA
- Diné College, Tsaile, AZ, USA
| | - Audrey Ricks
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Kayla Tabb
- Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Sharon Sandman
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | - Shine K Salt
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | - Cameron Curley
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
| | | | - Caleigh A Curley
- Department of Health Sciences, Northern Arizona University, Flagstaff, AZ, USA
| | - Del Yazzie
- Navajo Epidemiology Center, the Navajo Nation Department of Health, Window Rock, AZ, USA
| | - Sonya Sunhi Shin
- Brigham and Women's Hospital, Division of Global Health Equity, Boston, MA, USA
- Community Outreach and Patient Empowerment, Gallup, NM, USA
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11
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Yazzie D, Tallis K, Curley C, Sanderson PR, Eddie R, Shin S, Behrens TK, George C, Antone-Nez R, Jumbo-Rintila S, Begay GA, de Heer H“D. The Navajo Nation Healthy Diné Nation Act: A Description of Community Wellness Projects Funded by a 2% Tax on Minimal-to-No-Nutritious-Value Foods. J Public Health Manag Pract 2022; 28:E471-E479. [PMID: 34016908 PMCID: PMC8589869 DOI: 10.1097/phh.0000000000001371] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
CONTEXT To promote the health of the Navajo people, the Navajo Nation passed the Healthy Diné Nation Act (HDNA) in 2014. The HDNA included a 2% tax on "minimal-to-no-nutritional-value" foods and waived 5% sales tax on healthy foods, the first such policy in the United States and any sovereign Tribal nation. Uniquely aligned with Tribal government structures, revenue was directly allocated to 110 small local government entities (Chapters) for self-determined wellness projects. OBJECTIVE To characterize HDNA-funded wellness projects, test for variation in project type, and funding amount over time by region and community size. DESIGN Longitudinal study assessing funded wellness projects from tax inception through 2019. SETTING The Navajo Nation. PARTICIPANTS One hundred ten Navajo Nation Chapters receiving funding for self-determined wellness projects. OUTCOME MEASURES The categories and specific types of wellness projects and funding over 4 years by region and community size. RESULTS Of revenue collected in 2015-2018, more than 99.1% was disbursed through 2019 ($4.6 million, $13 385 annually per community) across 1315 wellness projects (12 per community). The built recreational environment category received 38.6% of funds, equipment/supplies 16.5%, instruction 15.7%, food and water initiatives 14.0%, and social events 10.2%. Most common specific projects were walking trails ($648 470), exercise equipment ($585 675), food for events ($288 879), playgrounds ($287 471), and greenhouses ($275 554). Only the proportion allocated to instruction changed significantly over time (increased 2% annually, P = .02). Smaller communities (population <1000) allocated significantly higher proportions to traditional, agricultural, and intergenerational projects and less to the built environment. CONCLUSIONS Through 2019, more than 99% of HDNA revenue was successfully disbursed to 110 rural, Tribal communities. Communities chose projects related to promoting the built recreational environment, agriculture, and fitness/nutrition education, with smaller communities emphasizing cultural and intergenerational projects. These findings can inform other indigenous nations considering similar policies and funding distributions.
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Affiliation(s)
- Del Yazzie
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Kristen Tallis
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Caleigh Curley
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Priscilla R. Sanderson
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Regina Eddie
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Sonya Shin
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Timothy K. Behrens
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Carmen George
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Ramona Antone-Nez
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Shirleen Jumbo-Rintila
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Gloria Ann Begay
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
| | - Hendrik “Dirk” de Heer
- Navajo Epidemiology Center, Navajo Department of Health, Window Rock, Arizona (Mr Yazzie and Ms Antone-Nez); Department of Health Sciences (Mss Tallis, Curley, and Sanderson and Drs Behrens and de Heer) and College of Nursing (Dr Eddie), Northern Arizona University, Flagstaff, Arizona; Brigham and Women's Hospital, Boston, Massachusetts (Dr Shin and Ms George); College of Health Sciences, University of Wisconsin-Milwaukee, Milwaukee, Wisconsin (Dr Behrens); Navajo Division of Community Development, Window Rock, Arizona (Ms Jumbo-Rintila); and Diné Food Sovereignty Alliance, Gallup, New Mexico (Ms Begay)
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Grout L, Mizdrak A, Nghiem N, Jones AC, Blakely T, Ni Mhurchu C, Cleghorn C. Potential effect of real-world junk food and sugar-sweetened beverage taxes on population health, health system costs and greenhouse gas emissions in New Zealand: a modelling study. BMJNPH 2022; 5:19-35. [PMID: 35814724 PMCID: PMC9237873 DOI: 10.1136/bmjnph-2021-000376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Accepted: 12/22/2021] [Indexed: 11/13/2022]
Abstract
Poor diet is a major risk factor for excess weight gain and obesity-related diseases, including cardiovascular diseases, type 2 diabetes mellitus, osteoarthritis and several cancers. This paper aims to assess the potential impacts of real-world food and beverage taxes on change in dietary risk factors, health gains (in quality-adjusted life years (QALYs)), health system costs and greenhouse gas (GHG) emissions as if they had all been implemented in New Zealand (NZ). Ten taxes or tax packages were modelled. A proportional multistate life table model was used to predict resultant QALYs and costs over the remaining lifespan of the NZ population alive in 2011, as well as GHG emissions. QALYs ranged from 12.5 (95% uncertainty interval (UI) 10.2 to 15.0; 3% discount rate) per 1000 population for the import tax on sugar-sweetened beverages (SSB) in Palau to 143 (95% UI 118 to 171) per 1000 population for the excise duties on saturated fat, chocolate and sweets in Denmark, while health expenditure savings ranged from 2011 NZ$245 (95% UI 188 to 310; 2020 US$185) per capita to NZ$2770 (95% UI 2140 to 3480; US$2100) per capita, respectively. The modelled taxes resulted in decreases in GHG emissions from baseline diets, ranging from −0.2% for the tax on SSB in Barbados to −2.8% for Denmark’s tax package. There is strong evidence for the implementation of food and beverage tax packages in NZ or similar high-income settings.
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Affiliation(s)
- Leah Grout
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago, Wellington, New Zealand
| | - Anja Mizdrak
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago, Wellington, New Zealand
| | - Nhung Nghiem
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago, Wellington, New Zealand
| | - Amanda C Jones
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago, Wellington, New Zealand
| | - Tony Blakely
- Population Interventions, Centre for Epidemiology and Biostatistics, The University of Melbourne School of Population and Global Health, Melbourne, Victoria, Australia
| | - Cliona Ni Mhurchu
- National Institute for Health Innovation, The University of Auckland, Auckland, New Zealand
- The George Institute for Global Health, Sydney, New South Wales, Australia
| | - Christine Cleghorn
- Burden of Disease Epidemiology, Equity and Cost-Effectiveness Program, University of Otago, Wellington, New Zealand
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13
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Machado P, Cediel G, Woods J, Baker P, Dickie S, Gomes FS, Scrinis G, Lawrence M. Evaluating intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model. Eur J Nutr 2022. [PMID: 35034166 DOI: 10.1007/s00394-021-02740-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 11/11/2021] [Indexed: 01/14/2023]
Abstract
PURPOSE To investigate intake levels of nutrients linked to non-communicable diseases in Australia using the novel combination of food processing and nutrient profiling metrics of the PAHO Nutrient Profile Model. METHODS Dietary intakes of 12,153 participants from the Australian Health Survey (2011-12) aged 2 + years were evaluated. Food items reported during a 24 h recall were classified using the NOVA system. The Pan-American Health Organization Nutrient Profile Model (PAHO NPM) was applied to identify processed and ultra-processed products with excessive content of critical nutrients. Differences in mean intakes and prevalence of excessive intakes of critical nutrients for groups of the population whose diets were made up of products with and without excessive content in critical nutrients were examined. RESULTS The majority of Australians consumed daily at least three processed and ultra-processed products identified as excessive in critical nutrients according to the PAHO NPM. Individuals consuming these products had higher intakes of free sugars (β = 8.9), total fats (β = 11.0), saturated fats (β = 4.6), trans fats (β = 0.2), and sodium (β = 1788 for adolescents and adults; β = 1769 for children 5-10 years; β = 1319 for children aged < 5 years) (p ≤ 0.001 for all nutrients) than individuals not consuming these foods. The prevalence of excessive intake of all critical nutrients also followed the same trend. CONCLUSION The PAHO NPM has shown to be a relevant tool to predict intake levels of nutrients linked to non-communicable diseases in Australia and, therefore, could be used to inform policy actions aimed at increasing the healthiness of food environments.
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14
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Popkin BM, Ng SW. The nutrition transition to a stage of high obesity and noncommunicable disease prevalence dominated by ultra-processed foods is not inevitable. Obes Rev 2022; 23:e13366. [PMID: 34632692 PMCID: PMC8639733 DOI: 10.1111/obr.13366] [Citation(s) in RCA: 80] [Impact Index Per Article: 40.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 08/24/2021] [Accepted: 09/05/2021] [Indexed: 12/18/2022]
Abstract
The Nutrition Transition model is presented with the nature and pace of change in key stages varying by location and subpopulations. At present, all high-income and many low- and middle-income countries are in a stage of the transition where nutrition-related noncommunicable diseases including obesity, type 2 diabetes, and hypertension are dominating adult morbidity and mortality and are very high or growing rapidly in prevalence. Some countries still have key subpopulations facing hunger and undernutrition defined by stunting or extreme thinness among adults. We call these double burden of malnutrition countries. All low- and middle-income countries face rapid growth in consumption of ultra-processed food and beverages, but it is not inevitable that these countries will reach the same high levels of consumption seen in high-income countries, with all the negative impacts of this diet on health. With great political and civil society commitment to adoption of policies shown in other countries to have improved dietary choices and social norms around foods, we can arrest and even reverse the rapid shift to diets dominated by a stage of high ultra-processed food intake and increasing prevalence of nutrition-related noncommunicable diseases.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health and the Carolina Population Center, University of North Carolina Chapel Hill, Chapel Hill, North Carolina, USA
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15
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Fagundes Grilo M, Taillie LS, Zancheta Ricardo C, Amaral Mais L, Bortoletto Martins AP, Duran AC. Prevalence of low-calorie sweeteners and related front-of-package claims in the Brazilian packaged food supply. J Acad Nutr Diet 2021; 122:1296-1304. [PMID: 34954081 DOI: 10.1016/j.jand.2021.12.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2020] [Revised: 10/28/2021] [Accepted: 12/17/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Low-calorie sweeteners (LCS) are increasingly being used worldwide, including in foods and beverages commonly consumed by children. OBJECTIVE To examine the prevalence of LCS in packaged foods and beverages sold in Brazil, whether LCS are added to products with advertising directed to children, and whether foods and beverages with LCS include front-of-package (FoP) LCS-related health and nutrition claims. DESIGN Cross-sectional study. SETTING A sample (n = 11,434) of packaged foods and beverages sold by the top five largest Brazilian food retailers was examined to identify LCS and added sugars and a subsample (n = 3,491) was examined to determine the presence of advertising directed to children and FoP LCS-related claims in foods and beverages with LCS. MAIN OUTCOME AND MEASURES The prevalence of foods and beverages with different types of LCS in the Brazilian food supply, among ultra-processed foods and beverages and among foods and beverages with added sugars were measured. Foods and beverages with advertising directed to children were checked to see if these products had LCS, and how many products with LCS had FoP labels with LCS-related claims. STATISTICAL ANALYSES Mean and 95% confidence intervals were used to determine the overall prevalence of foods and beverages with LCS and in the different assessed stratifications. RESULTS The prevalence of LCS was 9.3% (95% CI 8.8, 9.9) in Brazilian packaged foods and beverages, 14.6% (95% CI 13.8, 15.4) in ultra-processed products alone, and 5.7% (95% CI 4.2, 7.7) in foods and beverages with advertising directed to children. About 83% of food and beverage with LCS were also sweetened with added sugars. LCS were most frequently added to nonalcoholic sweetened beverages, breakfast cereals, and granola bars. Forty percent of foods and beverages with LCS did not present any front-of-package LCS-related claim. CONCLUSION This study shows that LCS are present in 15% of ultra-processed foods and beverages in Brazil, largely used in combination with added sugars, and are found in foods and beverages with advertising directed to children. Clearer FoP information regarding the presence of LCS, in particular in products with advertising directed to children, can help consumers make more informed choices regarding LCS consumption.
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Affiliation(s)
- Mariana Fagundes Grilo
- Graduate student, Graduate Program in Collective Health, School of Medical Sciences, University of Campinas (Unicamp), Tessalia Vieira de Camargo St., 126, Cidade Universitária, Campinas, Brazil 13083-887
| | - Lindsey Smith Taillie
- Assistant Professor, Department of Nutrition, Gillings School of Global Public Health, Carolina Population Center, University of North Carolina (UNC), Chapel Hill, Dauer Dr, 135 Chapel Hill, United States 27599
| | - Camila Zancheta Ricardo
- PhD student, Public Health Doctoral Program, School of Public Health, University of Chile, Independencia Av., 939, Región Metropolitana, Chile
| | - Laís Amaral Mais
- Researcher, Brazilian Institute for Consumer Defense (Idec), Dr. Costa Júnior St., 543, Água Branca, São Paulo, Brazil 05002-000
| | - Ana Paula Bortoletto Martins
- Researcher, Brazilian Institute for Consumer Defense (Idec), Dr. Costa Júnior St., 543, Água Branca, São Paulo, Brazil 05002-000
| | - Ana Clara Duran
- Research Scientist, Center for Food Studies and Research (NEPA), University of Campinas (Unicamp) University of Campinas (Unicamp), Albert Einstein Av., 291, Cidade Universitária, Campinas, Brazil 13083-852; Assistant Professor, Graduate Program in Collective Health, School of Medical Sciences, University of Campinas (Unicamp), Tessalia Vieira de Camargo St., 126, Cidade Universitária, Campinas, Brazil 13083-887; Research Fellow, Center for Epidemiological Studies in Nutrition and Health (NUPENS), University of São Paulo (USP). Dr Arnaldo Av., 715 São Paulo, Brazil 01246-904.
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Duran AC, Mialon M, Crosbie E, Jensen ML, Harris JL, Batis C, Corvalán C, Taillie LS. [Soluciones relacionadas con el entorno alimentario para prevenir la obesidad infantil en América Latina y en la población latina que vive en Estados Unidos]. Obes Rev 2021; 22 Suppl 5:e13344. [PMID: 34708531 DOI: 10.1111/obr.13344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Ana Clara Duran
- Núcleo de Estudos e Pesquisas em Alimentação (NEPA), Universidade Estadual de Campinas, Campinas, Brasil.,Núcleo de Pesquisas Epidemiológicas em Nutrição e Saúde, Universidade de São Paulo, São Paulo, Brasil
| | - Melissa Mialon
- Trinity Business School, Trinity College Dublin, Dublín, Irlanda
| | - Eric Crosbie
- School of Community and Health Sciences, University of Nevada, Reno, Nevada, EE. UU
| | - Melissa Lorena Jensen
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, EE. UU.,Escuela de Nutrición, Universidad de Costa Rica, San José, Costa Rica
| | - Jennifer L Harris
- Rudd Center for Food Policy and Obesity, University of Connecticut, Hartford, Connecticut, EE. UU
| | - Carolina Batis
- CONACYT, Centro de Investigación en Nutrición y Salud, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Camila Corvalán
- Instituto de Nutricion y Tecnologia de los Alimentos, Universidad de Chile, Santiago, Chile
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, Carolina del Norte, EE. UU
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Abstract
BACKGROUND Adherence to the Mediterranean diet has been decreasing in southern Europe, which could be linked to several cultural or educational factors. Our aim is to evaluate the extent to which economic aspects may also play a role, exploring the relationship between food prices in Portugal and adherence to the Mediterranean diet. METHODS We evaluated data from the Portuguese National Food, Nutrition, and Physical Activity Survey (IAN-AF 2015-2016) (n=3,591). Diet expenditures were estimated by attributing a retail price to each food group and the diet was transposed into the Mediterranean Diet Score used in the literature. Prices were gathered from five supermarket chains (65% of the Portuguese market share). Linear regression models were used to assess the association between different adherence levels to the MD levels and dietary costs. RESULTS Greater adherence to the MD was associated with a 21.2% (p< 0.05) rise in total dietary cost, which accounts for more 0.59€ in mean daily costs when compared with low adherence. High adherence individuals (vs. low adherence) had higher absolute mean daily costs with fish (0.62€/+285.8%; p< 0.05), fruits (0.26€/+115.8%; p< 0.05), and vegetables (0.10€/+100.9%; p< 0.05). The analysis stratified by education and income level showed significantly higher mean daily diet cost only amongst higher income groups. CONCLUSIONS Our findings suggest that greater adherence to the MD was positively and significantly associated with higher total dietary cost. Policies to improve population's diet should take into consideration the cost of healthy foods, especially for large low- and middle-income families.
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Popkin BM, Barquera S, Corvalan C, Hofman KJ, Monteiro C, Ng SW, Swart EC, Taillie LS. Towards unified and impactful policies to reduce ultra-processed food consumption and promote healthier eating. Lancet Diabetes Endocrinol 2021; 9:462-470. [PMID: 33865500 PMCID: PMC8217149 DOI: 10.1016/s2213-8587(21)00078-4] [Citation(s) in RCA: 108] [Impact Index Per Article: 36.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 03/08/2021] [Accepted: 03/09/2021] [Indexed: 02/07/2023]
Abstract
The global surges in obesity and nutrition-related non-communicable diseases (NCDs) have created a need for decisive new food policy initiatives. A major concern has been the impact of ultra-processed foods (UPFs) and ultra-processed drinks on weight gain and on the risk of several NCDs. These foods, generally high in calories, added sugar, sodium, and unhealthy fats, and poor in fibre, protein, and micronutrients, have extensive negative effects on human health and on the environment (due to their associated carbon emission and water use). There is a growing tendency worldwide, and especially in South America, for food companies to add micronutrients to UPFs to make health claims regarding these products, to which food-regulating authorities refer to fake foods. Although more than 45 countries and smaller subregional or urban entities have created taxes on ultra-processed drinks, such as sugar-sweetened beverages, only a few have adopted taxes on snacks and other UPFs, and none have added major subsidies for truly healthy, fresh or minimally processed food for people from lower socioeconomic backgrounds. Another major focus has been on developing effective package labelling. A smaller number of countries have selected the most impactful warning labels and linked them with other measures to create a mutually reinforcing set of policies; a few other countries have developed effective school food policies. We herein present in-depth results from key countries involved in all these actions and in comprehensive marketing controls, and conclude with our recommendations for the future. This field is quite new; progress to date is substantial, but much more is left to learn.
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Affiliation(s)
- Barry M Popkin
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Simon Barquera
- Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Mexico
| | - Camila Corvalan
- Institute of Nutrition and Food Technology, University of Chile, Santiago, Chile
| | - Karen J Hofman
- South African Medical Research Council Centre for Health Economics and Decision Science (PRICELESS SA), Faculty of Health Sciences School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Carlos Monteiro
- Center for Epidemiological Studies in Health and Nutrition, School of Public Health, University of São Paulo, São Paulo, Brazil
| | - Shu Wen Ng
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Elizabeth C Swart
- Department of Science and Innovation-National Research Foundation Centre of Excellence in Food Security, University of the Western Cape, Cape Town, South Africa
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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19
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Miracolo A, Sophiea M, Mills M, Kanavos P. Sin taxes and their effect on consumption, revenue generation and health improvement: a systematic literature review in Latin America. Health Policy Plan 2021; 36:790-810. [PMID: 33885782 PMCID: PMC8173601 DOI: 10.1093/heapol/czaa168] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/13/2020] [Indexed: 11/14/2022] Open
Abstract
Sin or public health taxes are excise taxes imposed on the consumption of potentially harmful goods for health [sugar-sweetened beverages (SSBs), tobacco, alcohol, among others], aiming to reduce consumption, raise additional revenue and/or improve population health. This paper assesses the extent to which sin taxes (a) can reduce consumption of potentially harmful goods, (b) raise revenue for national health systems and (c) contribute to population health in Latin America. A systematic literature review was conducted on peer-reviewed and grey literature; endpoints included: impact of raising sin taxes on consumption, ability to raise revenue for health and the possibility of population health improvements. Risk of bias for each study was assessed. The synthesis of the literature on sin tax implementation showed improvements in all three endpoints across the study countries. Following the introduction of sin taxes or by simulating their potential impact, nearly all studies explicitly reported that consumption of potentially harmful goods (mainly SSBs and tobacco) declined; revenue was found to have increased in almost all countries, suggesting that there may be additional scope for further tax increase. Simulated improvements in population health have also been shown, by demonstrating a relationship between sin tax increases and reduction in prevalence of diabetes, stroke, heart attacks and associated deaths. However, sin tax effects on health would be better quantified over the long-term. Data quality and availability challenges did place some limitations on sin tax impact assessment. Sin taxes can be effective in reducing consumption of potentially harmful goods, improve population health and generate additional revenue. Promoting further research on this topic should be a priority.
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Affiliation(s)
- Aurelio Miracolo
- Department of Health Policy and Medical Technology Research Group - LSE Health, The London School of Economics and Political Science, Cowdrey House, Houghton Street, London WC2A 2AE, UK
| | - Marisa Sophiea
- Faculty of Medicine, School of Public Health, Imperial College, London, Medical School Building, St Mary's Hospital, Norfolk Place, London W2 1PG, UK
| | - Mackenzie Mills
- Department of Health Policy and Medical Technology Research Group - LSE Health, The London School of Economics and Political Science, Cowdrey House, Houghton Street, London WC2A 2AE, UK
| | - Panos Kanavos
- Department of Health Policy and Medical Technology Research Group - LSE Health, The London School of Economics and Political Science, Cowdrey House, Houghton Street, London WC2A 2AE, UK
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Duran AC, Mialon M, Crosbie E, Jensen ML, Harris JL, Batis C, Corvalán C, Taillie LS. Food environment solutions for childhood obesity in Latin America and among Latinos living in the United States. Obes Rev 2021; 22 Suppl 3:e13237. [PMID: 34152071 PMCID: PMC8365715 DOI: 10.1111/obr.13237] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 02/26/2021] [Indexed: 12/23/2022]
Abstract
The food environment is a major contributor to unhealthy diets in children and, therefore, to the increasing rates of obesity. Acclaimed by scholars across the world, Latin American countries have been leaders in implementing policies that target different aspects of the food environment. Evidence on the nature and to what extent children are exposed and respond to unhealthy food environments in the region and among Latinos in the United States is, however, deficient. The objective of this review is to use the integrated International Network for Food and Obesity/noncommunicable diseases (NCDs) Research, Monitoring and Action Support (INFORMAS) framework to create healthy food environment to (i) compare the key elements of childhood obesity-related food environments in Latin America and for Latinos living in the United States; (ii) describe the evidence on solutions to improve childhood obesity-related food environments; and (iii) identify research priorities to inform solutions to fight childhood obesity in these populations. We found that an integrated body of evidence is needed to inform an optimal package of policies to improve food environments to which children in Latin America and Latino children in the United States are exposed and more efficiently translate policy solutions to help curb growing childhood obesity levels across borders.
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Affiliation(s)
- Ana Clara Duran
- Center for Food Studies and Research (NEPA)University of CampinasCampinasBrazil
- Center for Epidemiological Studies in Nutrition and HealthUniversity of São PauloSão PauloBrazil
| | - Melissa Mialon
- Trinity Business SchoolTrinity College DublinDublinIreland
| | - Eric Crosbie
- School of Community and Health SciencesUniversity of NevadaRenoNevadaUSA
| | - Melissa Lorena Jensen
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordConnecticutUSA
- School of Nutrition, University of Costa RicaSan JoséCosta Rica
| | - Jennifer L. Harris
- Rudd Center for Food Policy and ObesityUniversity of ConnecticutHartfordConnecticutUSA
| | - Carolina Batis
- CONACYT, Health and Nutrition Research CenterNational Institute of Public HealthCuernavacaMexico
| | - Camila Corvalán
- Instituto de Nutricion y Tecnologia de AlimentosUniversity of ChileSantiagoChile
| | - Lindsey Smith Taillie
- Department of Nutrition, Gillings School of Global Public Health, and Carolina Population CenterUniversity of North Carolina at Chapel HillChapel HillNorth CarolinaUSA
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Bandy LK, Scarborough P, Harrington RA, Rayner M, Jebb SA. The sugar content of foods in the UK by category and company: A repeated cross-sectional study, 2015-2018. PLoS Med 2021; 18:e1003647. [PMID: 34003863 PMCID: PMC8171925 DOI: 10.1371/journal.pmed.1003647] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Revised: 06/02/2021] [Accepted: 05/07/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Consumption of free sugars in the UK greatly exceeds dietary recommendations. Public Health England (PHE) has set voluntary targets for industry to reduce the sales-weighted mean sugar content of key food categories contributing to sugar intake by 5% by 2018 and 20% by 2020. The aim of this study was to assess changes in the sales-weighted mean sugar content and total volume sales of sugar in selected food categories among UK companies between 2015 and 2018. METHODS AND FINDINGS We used sales data from Euromonitor, which estimates total annual retail sales of packaged foods, for 5 categories-biscuits and cereal bars, breakfast cereals, chocolate confectionery, sugar confectionery, and yoghurts-for 4 consecutive years (2015-2018). This analysis includes 353 brands (groups of products with the same name) sold by 99 different companies. These data were linked with nutrient composition data collected online from supermarket websites over 2015-2018 by Edge by Ascential. The main outcome measures were sales volume, sales-weighted mean sugar content, and total volume of sugar sold by category and company. Our results show that between 2015 and 2018 the sales-weighted mean sugar content of all included foods fell by 5.2% (95% CI -9.4%, -1.4%), from 28.7 g/100 g (95% CI 27.2, 30.4) to 27.2 g/100 g (95% CI 25.8, 28.4). The greatest change seen was in yoghurts (-17.0% [95% CI -26.8%, -7.1%]) and breakfast cereals (-13.3% [95% CI -19.2%, -7.4%]), with only small reductions in sugar confectionery (-2.4% [95% CI -4.2%, -0.6%]) and chocolate confectionery (-1.0% [95% CI -3.1, 1.2]). Our results show that total volume of sugars sold per capita fell from 21.4 g/d (95% CI 20.3, 22.7) to 19.7 g/d (95% CI 18.8, 20.7), a reduction of 7.5% (95% CI -13.1%, -2.8%). Of the 50 companies representing the top 10 companies in each category, 24 met the 5% reduction target set by PHE for 2018. The key limitations of this study are that it does not encompass the whole food market and is limited by its use of brand-level sales data, rather than individual product sales data. CONCLUSIONS Our findings show there has been a small reduction in total volume sales of sugar in the included categories, primarily due to reductions in the sugar content of yoghurts and breakfast cereals. Additional policy measures may be needed to accelerate progress in categories such as sugar confectionery and chocolate confectionery if the 2020 PHE voluntary sugar reduction targets are to be met.
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Affiliation(s)
- Lauren K. Bandy
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
- * E-mail:
| | - Peter Scarborough
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Richard A. Harrington
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Mike Rayner
- Nuffield Department of Population Health, University of Oxford, Oxford, United Kingdom
| | - Susan A. Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
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Abstract
PURPOSE OF REVIEW Interest in taxes on unhealthy foods and beverages as a public health tool has increased in recent years. This paper aimed to summarise recent evidence of the impact of taxes on unhealthy foods and beverages on food purchases, and discuss opportunities to advance knowledge and policy impact. RECENT FINDINGS Evaluations of taxes on unhealthy foods and beverages have shown reductions in purchases of targeted unhealthy products and nutrients. Similarly, data from multiple sources demonstrate that as prices of unhealthy foods and beverages increase, purchase volume decreases. However, studies indicate potential for substitution to non-taxed unhealthy foods, which needs to be factored into taxation design. Taxes on unhealthy foods and beverages are a promising strategy to improve population diets. Further research is required to understand food industry responses to tax implementation, as well as the impact of taxes on population and planetary health outcomes.
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Affiliation(s)
- Gary Sacks
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia.
| | - Janelle Kwon
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
| | - Kathryn Backholer
- Global Obesity Centre, Institute for Health Transformation, Deakin University, 221 Burwood Highway, Burwood, Victoria, 3125, Australia
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Hernández-F M, Cantoral A, Colchero MA. Taxes to Unhealthy Food and Beverages and Oral Health in Mexico: An Observational Study. Caries Res 2021; 55:183-192. [PMID: 33853058 DOI: 10.1159/000515223] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 02/14/2021] [Indexed: 11/19/2022] Open
Abstract
In January 2014, taxes on sugar-sweetened beverages and nonessential energy-dense food were implemented in Mexico to discourage the consumption of these products. Published evaluations have shown reductions in purchases of taxed food and beverages associated with the implementation of this fiscal policy. Although there are some studies on the impact on health based on simulation studies, no evaluations with empirical data on changes in oral health have been published. We used administrative records and data from an epidemiological surveillance system to estimate changes in (1) outpatient visits related to dental caries; (2) having experienced dental caries: Decayed, Missing and Filled Teeth (DMFT) >0 for permanent dentition or dmft >0 for primary dentition (dmft); (3) number of teeth with caries experience (DMFT and dmft), (4) cases with DMFT >0 or dmft >0, and (5) the series of mean DMFT or dmft, associated with the taxes. We estimated probit and negative binomial models for outcomes at individual level, and interrupted time series analysis for population-level outcomes. The implementation of the taxes was associated with negative changes in the trends of outpatient visits, as well as for cases with DMFT >0, dmft >0 and mean DMFT. Taxes were also associated with a lower probability of having experienced dental caries and with a lower number of teeth with caries experience in the samples studied. Our results suggest positive impacts of the implementation of taxes on unhealthy food and beverages in the oral health of Mexicans, which are the first health benefits observed, and add to the health benefits predicted by modeling studies.
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Affiliation(s)
- Mauricio Hernández-F
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - Alejandra Cantoral
- Center for Research on Nutrition and Health, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
| | - M Arantxa Colchero
- Center for Health Systems Research, Instituto Nacional de Salud Pública, Cuernavaca, Mexico
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Vilchis-Gil J, Klünder-Klünder M, Duque X, Martínez-Andrade G, Martínez-Almaráz A, Beristain-Lujano B, Flores-Huerta S. Impact of a Nutrition-Related Community Intervention on the Quantity and Quality of Children's School almuerzo. Life (Basel) 2021; 11:253. [PMID: 33808597 DOI: 10.3390/life11030253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/12/2021] [Accepted: 03/14/2021] [Indexed: 11/17/2022] Open
Abstract
Foods and beverages that schoolchildren carry in their lunchboxes have high energy values but lack plain water, fresh fruits and vegetables. A nutrition-related community intervention on the quantity and quality of school almuerzo was performed, in which four primary schools participated, as part of two groups: 225 children in the intervention group (IG) and 177 children in the control group (CG). The parents from the IG had access to a website where they could consult information on eating habits and physical activity or school almuerzo menus. They were sent weekly text messages on their mobile phones and attended in-person sessions. Anthropometric measurements and surveys were performed in both groups at the start of the study, as well as after 6 and 12 months. The school almuerzo was assessed by recording foods that the children brought in their lunchboxes. At baseline, 88% of children brought a school almuerzo, 37% fruit, 17% vegetables, 40% plain water and 50% sweet drinks. In both groups, 50% of children brought a school almuerzo with an energy value above the recommended value (>340 kcal) during follow-up; however, the percentage of children who brought sweet drinks decreased (p < 0.05), with sweet drinks contributing between 26% and 33% of the calories in the school almuerzo. In the IG, the quantity in milliliters of plain water increased at the end of the follow-up period (p = 0.044). From the point of view of food-and-beverage quantity and quality, school almuerzo were unhealthy for both groups. The intervention failed to increase the frequency with which parents provided children with school almuerzo or enhance the quality of the latter.
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Illescas-Zárate D, Batis C, Ramírez-Silva I, Torres-Álvarez R, Rivera JA, Barrientos-Gutiérrez T. Potential Impact of the Nonessential Energy-Dense Foods Tax on the Prevalence of Overweight and Obesity in Children: A Modeling Study. Front Public Health 2021; 8:591696. [PMID: 33634061 PMCID: PMC7902009 DOI: 10.3389/fpubh.2020.591696] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 11/30/2020] [Indexed: 11/22/2022] Open
Abstract
Background: Consumption of foods high in energy, sugar, fat, and salt contributes to the increase in body mass index and the prevalence of overweight and obesity in children. Mexico implemented an 8% tax to non-essential energy-dense foods (NEDF) in 2014 as part of a national strategy to reduce obesity. Objective: We modeled the potential effect of the NEDF tax on body mass index and overweight and obesity in Mexican children (6–17 years). Materials and Methods: We used the Dynamic Childhood Growth and Obesity Model calibrated to Mexican children to simulate the potential 1-year effect of the NEDF tax on body weight. Inputs for the model included NEDF consumption, weight, and height, obtained from the 2012 Mexican National Health and Nutrition Survey. To project the potential impact of the tax, we ran a first simulation without intervention and another reducing the caloric intake from NEDF in the proportion observed in the Mexican population after the tax (−5.1%). The tax effect was defined as the absolute difference in body mass index and prevalence of overweight and obesity between both models. Results: The tax on NEDF should lead to a mean reduction of 4.1 g or 17.4 kcal/day of NEDF at the population level. One year after the tax, mean body weight and body mass index should decrease 0.40 kg and 0.19 kg/m2; this translates into −1.7 and −0.4% points in overweight and obesity, respectively. Conclusions: The use of fiscal instruments to discourage the consumption of NEDF could help to reduce the prevalence of overweight and obesity in children.
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Affiliation(s)
- Daniel Illescas-Zárate
- Center for Nutrition and Health Research, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Carolina Batis
- CONACYT-Center for Nutrition and Health Research, National Institute of Public Health, Cuernavaca, Morelos, Mexico
| | - Ivonne Ramírez-Silva
- Center for Nutrition and Health Research, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Rossana Torres-Álvarez
- Center for Research in Population Health, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Juan A Rivera
- Center for Nutrition and Health Research, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
| | - Tonatiuh Barrientos-Gutiérrez
- Center for Research in Population Health, National Institute of Public Health of Mexico, Cuernavaca, Morelos, Mexico
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Øvrebø B, Halkjelsvik TB, Meisfjord JR, Bere E, Hart RK. The effects of an abrupt increase in taxes on candy and soda in Norway: an observational study of retail sales. Int J Behav Nutr Phys Act 2020; 17:115. [PMID: 32928228 PMCID: PMC7491168 DOI: 10.1186/s12966-020-01017-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Accepted: 09/02/2020] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Fiscal policies are used to promote a healthier diet; however, there is still a call for real-world evaluations of taxes on unhealthy foods and beverages. We aimed to evaluate the effect of an abrupt increase, of respectively 80 and 40%, in the excising Norwegian taxes on candy and beverages on volume sales of candy and soda. We expected sales to fall. METHODS We analyzed electronic point of sale data covering approximately 98% of volume sales of grocery stores in Norway. In two pre-registered models with weekly (log-)sales of taxed candy and soda from 3884 individual stores, we modeled the difference between the jump (discontinuity) in the trend around the time of the increase in taxes and the corresponding jump in the trend in a control season from the previous years (Model 1). In addition, we modeled the difference between the intervention and the control season in their changes in average sales (Model 2). RESULTS Model 1 showed a 6.1% (one-sided 95% CI: not applicable (NA), 23.4, p-value = 0.26) increase and a - 3.9% (95% CI: NA, 4.9, p-value = 0.23) reduction in the differences in the jump in the trends, for candy and soda, respectively. The second model showed a relative decrease of - 4.9% (95% CI: NA, 1.0, p-value = 0.08) in the average sales of candy and an increase of 1.5% (95% CI: NA, 5.0, p-value = 0.24) in sales of soda. Supplementary analyses suggested that the results were sensitive to clustering on the time dimension. CONCLUSIONS When using two different quasi-experimental designs to model changes in volume sales of taxed candy and soda, we were not able to detect reductions in sales that coincided with an increase in the taxes. Variation across time makes it difficult to detect potentially small changes in sales even when using an entire country's worth of sales data on the level of individual stores. We speculate that the tax increases were too modest to affect the prices to alter sales sufficiently.
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Affiliation(s)
- Bente Øvrebø
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway. .,Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway. .,Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway.
| | - Torleif B Halkjelsvik
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.,Department of Alcohol, Tobacco and Drugs, Norwegian Institute of Public Health, Oslo, Norway
| | - Jørgen R Meisfjord
- Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
| | - Elling Bere
- Faculty of Health and Sport Sciences, University of Agder, Kristiansand, Norway.,Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
| | - Rannveig K Hart
- Centre for Evaluation of Public Health Measures, Norwegian Institute of Public Health, Oslo, Norway.,Department of Health and Inequalities, Norwegian Institute of Public Health, Oslo, Norway
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Vandevijvere S, Pedroni C, De Ridder K, Castetbon K. The Cost of Diets According to Their Caloric Share of Ultraprocessed and Minimally Processed Foods in Belgium. Nutrients 2020; 12:E2787. [PMID: 32933051 DOI: 10.3390/nu12092787] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 09/01/2020] [Accepted: 09/09/2020] [Indexed: 12/30/2022] Open
Abstract
Background: This study estimated the monetary cost of diets with higher and lower caloric shares of ultraprocessed food products (UPF) and unprocessed/minimally processed foods (MPF) in Belgium for various sociodemographic groups. Methods: Data from the latest nationally representative Food Consumption Survey (FCS) 2014–2015 (n = 3146; 3–64 years) were used. Dietary data were collected through two nonconsecutive 24-hour recalls (food diaries for children). Average prices for >2000 food items (year 2014) were derived from GfK ConsumerScan panel data and linked with foods consumed in the FCS. Foods eaten were categorized by their extent of processing using the NOVA classification. The average caloric share (percentage of daily energy intake) of UPF and MPF were calculated. The mean diet cost was compared across the UPF and MPF contribution tertiles, using linear regression. Results: The average price per 100 kcal for UPF was significantly cheaper (EUR 0.55; 95%CI = 0.45–0.64) than for MPF (EUR 1.29; 95% CI = 1.27–1.31). UPF contributed between 21.9% (female adults) and 29.9% (young boys), while MPF contributed between 29.5% (male adolescents) and 42.3% (female adults) to the daily dietary cost. The contribution of MPF to the daily dietary cost was significantly higher for individuals with a higher household education level compared to those with a lower household education level (p < 0.01). Adjusted for covariates, the average dietary cost per 2000 kcal was significantly lower for individuals in the highest compared to the lowest tertile for the proportion of daily energy consumed from UPF (EUR −0.37 ± 0.13; p = 0.006), and significantly higher for individuals in the highest compared to the lowest tertile for proportion of daily energy consumed from MPF (EUR 1.18 ± 0.12, p < 0.001). Conclusion: Diets with a larger caloric share of UPF were significantly cheaper than those with a lower contribution of these products, while the opposite was found for MPF. Policies that improve relative affordability and accessibility of MPF are recommended.
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Yazzie D, Tallis K, Curley C, Sanderson PR, Eddie R, Behrens TK, Antone-Nez R, Ashley M, Benally HJ, Begay GA, Jumbo-Rintila Ma S, de Heer HD. The Navajo Nation Healthy Diné Nation Act: A Two Percent Tax on Foods of Minimal-to-No Nutritious Value, 2015-2019. Prev Chronic Dis 2020; 17:E100. [PMID: 32886061 PMCID: PMC7478152 DOI: 10.5888/pcd17.200038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Our study summarizes tax revenue and disbursements from the Navajo Nation Healthy Diné Nation Act of 2014, which included a 2% tax on foods of minimal-to-no nutritional value (junk food tax), the first in the United States and in any sovereign tribal nation. Since the tax was implemented in 2015, its gross revenue has been $7.58 million, including $1,887,323 in 2016, the first full year. Revenue decreased in absolute value by 3.2% in 2017, 1.2% in 2018, and 4.6% in 2019, a significant downward trend (P = .02). Revenue allocated for wellness projects averaged $13,171 annually for each local community, with over 99% successfully disbursed and more rural areas generating significantly less revenue. Our results provide context on expected revenue, decreases over time, and feasibility for tribal and rural communities considering similar policies.
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Affiliation(s)
- Del Yazzie
- Navajo Department of Health, Navajo Epidemiology Center, Window Rock, Arizona.,Navajo Epidemiology Center, Window Rock Blvd, Administration Bldg #2, PO Box 1390, Window Rock, AZ 86515.
| | - Kristen Tallis
- Northern Arizona University, Department of Health Sciences, Flagstaff, Arizona
| | - Caleigh Curley
- Northern Arizona University, Department of Health Sciences, Flagstaff, Arizona
| | | | - Regina Eddie
- Northern Arizona University, School of Nursing, Flagstaff, Arizona
| | - Timothy K Behrens
- University of Wisconsin-Milwaukee, College of Health Sciences, Milwaukee, Wisconsin
| | - Ramona Antone-Nez
- Navajo Department of Health, Navajo Epidemiology Center, Window Rock, Arizona
| | - Martin Ashley
- Office of the Navajo Nation Tax Commission, St. Michaels, Arizona
| | | | | | | | - Hendrik D de Heer
- Northern Arizona University, Department of Health Sciences, Flagstaff, Arizona
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Duran AC, Ricardo CZ, Mais LA, Bortoletto Martins AP. Role of different nutrient profiling models in identifying targeted foods for front-of-package food labelling in Brazil. Public Health Nutr 2021; 24:1514-25. [PMID: 32515717 DOI: 10.1017/S1368980019005056] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Objective: To compare the degree of strictness and agreement of different nutrient profiling models (NPM) used to identify which foods would be required to show front-of-package (FOP) warning labels. Design: Using data of 11 434 packaged foods found in the five largest food retailers in Brazil, we used two published NPM: the Pan American Health Organization (PAHO) model and the NPM used in the Chilean nutritional FOP labelling policy, and compared them with a NPM proposed by the Brazilian National Health Surveillance Agency (Anvisa). The proportion of foods that would be required to show FOP warning labels was calculated overall and by food category. We also tested whether a modified version of the PAHO NPM would behave similarly to the original version. Setting: Brazil. Results: Two-thirds of the packaged products (62 %) would receive FOP warning labels under the PAHO NPM, as compared with 45 % of products using the proposed Anvisa NPM and 41 % if the Chilean NPM was applied. The PAHO NPM identified more foods high in critical nutrients such as sweetened dairy and non-dairy beverages, canned vegetables and convenience foods. Overall agreement between models was considered good with kappa coefficient ranging from 0·57 to 0·92 but was lower for some food categories. Conclusions: We found variations in the degree of strictness and agreement between assessed NPM. The PAHO NPM identified more foods and beverages high in sugar which are among the top contributors to sugar and energy intake in Brazil.
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Pfinder M, Heise TL, Hilton Boon M, Pega F, Fenton C, Griebler U, Gartlehner G, Sommer I, Katikireddi SV, Lhachimi SK. Taxation of unprocessed sugar or sugar-added foods for reducing their consumption and preventing obesity or other adverse health outcomes. Cochrane Database Syst Rev 2020; 4:CD012333. [PMID: 32270494 PMCID: PMC7141932 DOI: 10.1002/14651858.cd012333.pub2] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND Global prevalence of overweight and obesity are alarming. For tackling this public health problem, preventive public health and policy actions are urgently needed. Some countries implemented food taxes in the past and some were subsequently abolished. Some countries, such as Norway, Hungary, Denmark, Bermuda, Dominica, St. Vincent and the Grenadines, and the Navajo Nation (USA), specifically implemented taxes on unprocessed sugar and sugar-added foods. These taxes on unprocessed sugar and sugar-added foods are fiscal policy interventions, implemented to decrease their consumption and in turn reduce adverse health-related, economic and social effects associated with these food products. OBJECTIVES To assess the effects of taxation of unprocessed sugar or sugar-added foods in the general population on the consumption of unprocessed sugar or sugar-added foods, the prevalence and incidence of overweight and obesity, and the prevalence and incidence of other diet-related health outcomes. SEARCH METHODS We searched CENTRAL, Cochrane Database of Systematic Reviews, MEDLINE, Embase and 15 other databases and trials registers on 12 September 2019. We handsearched the reference list of all records of included studies, searched websites of international organisations and institutions, and contacted review advisory group members to identify planned, ongoing or unpublished studies. SELECTION CRITERIA We included studies with the following populations: children (0 to 17 years) and adults (18 years or older) from any country and setting. Exclusion applied to studies with specific subgroups, such as people with any disease who were overweight or obese as a side-effect of the disease. The review included studies with taxes on or artificial increases of selling prices for unprocessed sugar or food products that contain added sugar (e.g. sweets, ice cream, confectionery, and bakery products), or both, as intervention, regardless of the taxation level or price increase. In line with Cochrane Effective Practice and Organisation of Care (EPOC) criteria, we included randomised controlled trials (RCTs), cluster-randomised controlled trials (cRCTs), non-randomised controlled trials (nRCTs), controlled before-after (CBA) studies, and interrupted time series (ITS) studies. We included controlled studies with more than one intervention or control site and ITS studies with a clearly defined intervention time and at least three data points before and three after the intervention. Our primary outcomes were consumption of unprocessed sugar or sugar-added foods, energy intake, overweight, and obesity. Our secondary outcomes were substitution and diet, expenditure, demand, and other health outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently screened all eligible records for inclusion, assessed the risk of bias, and performed data extraction.Two review authors independently assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS We retrieved a total of 24,454 records. After deduplicating records, 18,767 records remained for title and abstract screening. Of 11 potentially relevant studies, we included one ITS study with 40,210 household-level observations from the Hungarian Household Budget and Living Conditions Survey. The baseline ranged from January 2008 to August 2011, the intervention was implemented on September 2011, and follow-up was until December 2012 (16 months). The intervention was a tax - the so-called 'Hungarian public health product tax' - on sugar-added foods, including selected foods exceeding a specific sugar threshold value. The intervention includes co-interventions: the taxation of sugar-sweetened beverages (SSBs) and of foods high in salt or caffeine. The study provides evidence on the effect of taxing foods exceeding a specific sugar threshold value on the consumption of sugar-added foods. After implementation of the Hungarian public health product tax, the mean consumption of taxed sugar-added foods (measured in units of kg) decreased by 4.0% (standardised mean difference (SMD) -0.040, 95% confidence interval (CI) -0.07 to -0.01; very low-certainty evidence). The study was at low risk of bias in terms of performance bias, detection bias and reporting bias, with the shape of effect pre-specified and the intervention unlikely to have any effect on data collection. The study was at unclear risk of attrition bias and at high risk in terms of other bias and the independence of the intervention. We rated the certainty of the evidence as very low for the primary and secondary outcomes. The Hungarian public health product tax included a tax on sugar-added foods but did not include a tax on unprocessed sugar. We did not find eligible studies reporting on the taxation of unprocessed sugar. No studies reported on the primary outcomes of consumption of unprocessed sugar, energy intake, overweight, and obesity. No studies reported on the secondary outcomes of substitution and diet, demand, and other health outcomes. No studies reported on differential effects across population subgroups. We could not perform meta-analyses or pool study results. AUTHORS' CONCLUSIONS There was very limited evidence and the certainty of the evidence was very low. Despite the reported reduction in consumption of taxed sugar-added foods, we are uncertain whether taxing unprocessed sugar or sugar-added foods has an effect on reducing their consumption and preventing obesity or other adverse health outcomes. Further robustly conducted studies are required to draw concrete conclusions on the effectiveness of taxing unprocessed sugar or sugar-added foods for reducing their consumption and preventing obesity or other adverse health outcomes.
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Affiliation(s)
- Manuela Pfinder
- AOK Baden‐WürttembergDepartment of Health PromotionPresselstr. 19StuttgartBaden‐WürttembergGermany70191
- University Hospital, University of HeidelbergDepartment of General Practice and Health Services ResearchVossstrasse 2HeidelbergBremenGermanyD‐69115
- University of BremenInstitute for Public Health and Nursing Research, Health Sciences BremenBibliothekstr. 1BremenBremenGermany28359
| | - Thomas L Heise
- University of BremenInstitute for Public Health and Nursing Research, Health Sciences BremenBibliothekstr. 1BremenBremenGermany28359
- Leibniz Institute for Prevention Research and EpidemiologyResearch Group for Evidence‐Based Public HealthAchterstr. 30BremenGermany28359
| | - Michele Hilton Boon
- University of GlasgowMRC/CSO Social and Public Health Sciences UnitGlasgowUK
| | - Frank Pega
- University of OtagoPublic Health23A Mein Street, NewtownWellingtonNew Zealand6242
| | - Candida Fenton
- University of EdinburghUsher Institute of Population Health Sciences and InformaticsMedical SchoolTeviot PlaceEdinburghUKEH8 9AG
| | - Ursula Griebler
- Danube University KremsCochrane Austria, Department for Evidence‐based Medicine and EvaluationDr.‐Karl‐Dorrek Str. 30KremsAustria3500
| | - Gerald Gartlehner
- Danube University KremsCochrane Austria, Department for Evidence‐based Medicine and EvaluationDr.‐Karl‐Dorrek Str. 30KremsAustria3500
| | - Isolde Sommer
- Danube University KremsCochrane Austria, Department for Evidence‐based Medicine and EvaluationDr.‐Karl‐Dorrek Str. 30KremsAustria3500
| | | | - Stefan K Lhachimi
- Leibniz Institute for Prevention Research and EpidemiologyResearch Group for Evidence‐Based Public HealthAchterstr. 30BremenGermany28359
- University of BremenDepartment for Health Services Research, Institute for Public Health and Nursing Research, Health Sciences BremenBibliotheksstr. 1BremenGermany28359
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Batis C, Denova-Gutiérrez E, Estrada-Velasco BI, Rivera J. Malnutrition prevalence among children and women of reproductive age in Mexico by wealth, education level, urban/rural area and indigenous ethnicity. Public Health Nutr 2020; 23:s77-88. [PMID: 32148210 DOI: 10.1017/S1368980019004725] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare the prevalence of malnutrition (undernutrition and excess weight) by wealth, education level, ethnicity and urban/rural areas in Mexican children and women of reproductive age. DESIGN We compared the prevalence of overweight, obesity, wasting/underweight, stunting/short stature and anaemia by socioeconomic and ethnic indicators. For each indicator, we estimated prevalence ratios (PR) adjusted by all other socioeconomic and ethnic indicators. We analysed if results differed by urban/rural areas. SETTING Mexican National Health and Nutrition Survey 2012. PARTICIPANTS Children <5 years, non-pregnant women 11-19 years and non-pregnant women 20-49 years (n 33 244). RESULTS In most age groups, belonging to non-indigenous households, with high wealth, high education and in urban areas were inversely associated with stunting or short stature (PR ranging from 0·40 to 0·83), and wealth and education were inversely associated with anaemia (PR ranging from 0·53 to 0·78). The prevalence of overweight was similar across subgroups among children <5 years; however, among women 11-19 years, wealth, non-indigenous household and urban areas were positively associated (PR ranging from 1·16 to 1·33); and among women 20-49 years, education was inversely associated (PR 0·83). CONCLUSIONS Socially disadvantaged populations have a higher prevalence of undernutrition, whereas the prevalence of excess weight is either equal (children <5 years), slightly lower (women 11-19 years) or even higher (women 20-49 years) with lower education. These results highlight the need for specific actions to address social inequalities in malnutrition in the Mexican population.
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Zorbas C, Grigsby-Duffy L, Backholer K. Getting the Price Right: How Nutrition and Obesity Prevention Strategies Address Food and Beverage Pricing Within High-Income Countries. Curr Nutr Rep 2020; 9:42-53. [PMID: 31953676 DOI: 10.1007/s13668-020-00300-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE OF REVIEW Food and beverage prices are major influences on dietary intakes. International health bodies recommend leveraging food prices to create healthier food environments. A policy review was conducted to understand the extent to which national nutrition and obesity prevention policy strategies within high-income countries (i) consider food price as a determinant of health and (ii) propose and implement policies to rebalance food pricing towards healthier options. RECENT FINDINGS Policy strategies were inconsistent and fragmented in their inclusion of food prices as determinants of diet-related health. The equity benefits of pricing policies were often indicated. Fiscal measures and food subsidies in schools were the most commonly proposed and implemented pricing policies, predominantly used in Europe. Price is a pertinent but underutilized policy lever in nutrition policy. Comprehensive food and beverage pricing strategies need to be identified, adopted and implemented to improve population diets for everyone.
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Affiliation(s)
- Christina Zorbas
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia.
| | - Lily Grigsby-Duffy
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
| | - Kathryn Backholer
- Geelong, Australia, Global Obesity Centre (GLOBE), Institute for Health Transformation, Deakin University, Geelong, Australia
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Machado PP, Steele EM, Louzada MLDC, Levy RB, Rangan A, Woods J, Gill T, Scrinis G, Monteiro CA. Ultra-processed food consumption drives excessive free sugar intake among all age groups in Australia. Eur J Nutr 2019; 59:2783-2792. [PMID: 31676952 DOI: 10.1007/s00394-019-02125-y] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2019] [Accepted: 10/21/2019] [Indexed: 02/04/2023]
Abstract
OBJECTIVE To analyze the contribution of ultra-processed foods to the intake of free sugars among different age groups in Australia. METHODS Dietary intakes of 12,153 participants from the National Nutrition and Physical Activity Survey (2011-12) aged 2+ years were evaluated. Food items collected through two 24-h recalls were classified according to the NOVA system. The contribution of each NOVA food group and their subgroups to total energy intake was determined by age group. Mean free sugar content in diet fractions made up exclusively of ultra-processed foods, or of processed foods, or of a combination of un/minimally processed foods and culinary ingredients (which includes table sugar and honey) were compared. Across quintiles of the energy contribution of ultra-processed foods, differences in the intake of free sugars, as well as in the prevalence of excessive free sugar intake (≥ 10% of total energy) were examined. RESULTS Ultra-processed foods had the highest energy contribution among children, adolescents and adults in Australia, with older children and adolescents the highest consumers (53.1% and 54.3% of total energy, respectively). The diet fraction restricted to ultra-processed items contained significantly more free sugars than the two other diet fractions. Among all age groups, a positive and statistically significant linear association was found between quintiles of ultra-processed food consumption and both the average intake of free sugars and the prevalence of excessive free sugar intake. CONCLUSION Ultra-processed food consumption drives excessive free sugar intake among all age groups in Australia.
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Affiliation(s)
- Priscila Pereira Machado
- Programa de Pós-Graduação em Nutrição em Saúde Pública, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil.,Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil
| | - Eurídice Martinez Steele
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil
| | - Maria Laura da Costa Louzada
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil.,Departamento de Políticas Públicas e Saúde Coletiva, Universidade Federal de São Paulo, R. Silva Jardim, 136, Santos, 11015-020, Brazil
| | - Renata Bertazzi Levy
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil.,Departamento de Medicina Preventiva, Faculdade de Medicina, Universidade de São Paulo, Av. Dr. Arnaldo, 455, São Paulo, SP, 01246-903, Brazil
| | - Anna Rangan
- School of Life and Environmental Sciences, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Julie Woods
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, 3220, Australia
| | - Timothy Gill
- Boden Institute of Obesity, Nutrition, Exercise and Eating Disorders, Charles Perkins Centre, The University of Sydney, Camperdown, NSW, 2050, Australia
| | - Gyorgy Scrinis
- School of Agriculture and Food, The University of Melbourne, Parkville, Melbourne, 3010, Australia
| | - Carlos Augusto Monteiro
- Center for Epidemiological Research in Nutrition and Health, University of Sao Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil. .,Departamento de Nutrição, Faculdade de Saúde Pública, Universidade de São Paulo, Av. Dr. Arnaldo, 715, São Paulo, SP, 01246-904, Brazil.
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Oliveira N, Coelho GMDO, Cabral MC, Bezerra FF, Faerstein E, Canella DS. Association of body image (dis)satisfaction and perception with food consumption according to the NOVA classification: Pró-Saúde Study. Appetite 2019; 144:104464. [PMID: 31539579 DOI: 10.1016/j.appet.2019.104464] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Revised: 09/15/2019] [Accepted: 09/17/2019] [Indexed: 10/26/2022]
Abstract
The literature on body image and food consumption has generally focused on isolated food items, while overlooking the growing role of ultra-processed foods in the overall diet. The objective of this study was to assess the association of body image (dis)satisfaction and perception with food consumption, according to the NOVA classification, which takes into account the extent and purpose of industrial food processing. A silhouette scale developed considering the Brazilian adults' Body Mass Index was used to assess body image (dis)satisfaction and perception. Food consumption was evaluated using a Food Frequency Questionnaire, and its items were categorized into three groups: unprocessed or minimally-processed foods and culinary preparations; processed foods; ultra-processed foods. The association was assessed using linear regression models. A total of 514 of Brazilian university employees were evaluated. Women dissatisfied due to excess weight consumed less unprocessed or minimally-processed foods and culinary preparations (-6.6, 95% CI: -10.7; -2.5) and more ultra-processed foods (3.7, 95% CI: 0.1; 7.2) compared to satisfied. Women that overestimated their body size consumed less unprocessed or minimally-processed food and culinary preparations (-4.2, 95% CI: -7.3; -1.1), compared to those who had not distorted body image. Food consumption appears to be more strongly associated with body image (dis)satisfaction than with perception. An association was established between body image dissatisfaction and unhealthy eating habits. This relation deserves public health attention since it may contribute to the development of chronic diseases and reduce the quality of life and body image assessment could be adopted by nutritionists and other health professionals in their practice.
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Affiliation(s)
- Natália Oliveira
- Graduate Program of Food, Nutrition and Health, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Magno Cerqueira Cabral
- Graduate Program of Food, Nutrition and Health, Rio de Janeiro State University, Rio de Janeiro, Brazil
| | | | - Eduardo Faerstein
- Institute of Social Medicine, Rio de Janeiro State University, Rio de Janeiro, Brazil
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Abstract
OBJECTIVE To estimate the potential impact on body mass index (BMI) and prevalence of obesity of a 20% price increase in high sugar snacks. DESIGN Modelling study. SETTING General adult population of the United Kingdom. PARTICIPANTS 36 324 households with data on product level household expenditure from UK Kantar FMCG (fast moving consumer goods) panel for January 2012 to December 2013. Data were used to estimate changes in energy (kcal, 1 kcal=4.18 kJ=0.00418 MJ) purchase associated with a 20% price increase in high sugar snacks. Data for 2544 adults from waves 5 to 8 of the National Diet and Nutrition Survey (2012-16) were used to estimate resulting changes in BMI and prevalence of obesity. MAIN OUTCOME MEASURES The effect on per person take home energy purchases of a 20% price increase for three categories of high sugar snacks: confectionery (including chocolate), biscuits, and cakes. Health outcomes resulting from the price increase were measured as changes in weight, BMI (not overweight (BMI <25), overweight (BMI ≥25 and <30), and obese (BMI ≥30)), and prevalence of obesity. Results were stratified by household income and BMI. RESULTS For income groups combined, the average reduction in energy consumption for a 20% price increase in high sugar snacks was estimated to be 8.9×103 kcal (95% confidence interval -13.1×103 to -4.2×103 kcal). Using a static weight loss model, BMI was estimated to decrease by 0.53 (95% confidence interval -1.01 to -0.06) on average across all categories and income groups. This change could reduce the UK prevalence of obesity by 2.7 percentage points (95% confidence interval -3.7 to -1.7 percentage points) after one year. The impact of a 20% price increase in high sugar snacks on energy purchase was largest in low income households classified as obese and smallest in high income households classified as not overweight. CONCLUSIONS Increasing the price of high sugar snacks by 20% could reduce energy intake, BMI, and prevalence of obesity. This finding was in a UK context and was double that modelled for a similar price increase in sugar sweetened beverages.
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Affiliation(s)
- Pauline F D Scheelbeek
- Department of Population Health, London School of Hygiene and Tropical Medicine, London WC1E 7HT, UK
- Centre on Climate Change and Planetary Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Laura Cornelsen
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK
| | - Theresa M Marteau
- Behaviour and Health Research Unit, Institute of Public Health, University of Cambridge, Cambridge, UK
| | - Susan A Jebb
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Richard D Smith
- College of Medicine and Health, University of Exeter, Exeter, UK
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Powell LM, Jones K, Duran AC, Tarlov E, Zenk SN. The price of ultra-processed foods and beverages and adult body weight: Evidence from U.S. veterans. Econ Hum Biol 2019; 34:39-48. [PMID: 31204255 PMCID: PMC6897320 DOI: 10.1016/j.ehb.2019.05.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/31/2018] [Revised: 05/22/2019] [Accepted: 05/28/2019] [Indexed: 05/02/2023]
Abstract
The consumption of ultra-processed foods in the U.S. and globally has increased and is associated with lower diet quality, higher energy intake, higher body weight, and poorer health outcomes. This study drew on individual-level data on measured height and weight from U.S. Department of Veterans Affairs medical records for adults aged 20 to 64 from 2009 through 2014 linked to food and beverage price data from the Council for Community and Economic Research to examine the association between the price of ultra-processed foods and beverages and adult body mass index (BMI). We estimated geographic fixed effects models to control for unobserved heterogeneity of prices. We estimated separate models for men and women and we assessed differences in price sensitivity across subpopulations by socioeconomic status (SES). The results showed that a one-dollar increase in the price of ultra-processed foods and beverages was associated with 0.08 lower BMI units for men (p ≤ 0.05) (price elasticity of BMI of -0.01) and 0.14 lower BMI units for women (p ≤ 0.10) (price elasticity of BMI of -0.02). Higher prices of ultra-processed foods and beverages were associated with lower BMI among low-SES men (price elasticity of BMI of -0.02) and low-SES women (price elasticity of BMI of -0.07) but no statistically significant associations were found for middle- or high-SES men or women. Robustness checks based on the estimation of an individual-level fixed effects model found a consistent but smaller association between the price of ultra-processed foods and beverages and BMI among women (price elasticity of BMI of -0.01) with a relatively larger association for low-SES women (price elasticity of BMI of -0.04) but revealed no association for men highlighting the importance of accounting for individual-level unobserved heterogeneity.
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Affiliation(s)
- Lisa M Powell
- Health Policy and Administration, School of Public Health, University of Illinois at Chicago, United States.
| | - Kelly Jones
- Health Systems Science, College of Nursing, University of Illinois at Chicago, United States
| | | | - Elizabeth Tarlov
- College of Nursing, University of Illinois at Chicago, Center of Innovation for Complex Chronic Healthcare, Edward Hines, Jr. VA Hospital, United States
| | - Shannon N Zenk
- Health Systems Science, College of Nursing, University of Illinois at Chicago
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Veatupu L, Puloka V, Smith M, McKerchar C, Signal L. Me'akai in Tonga: Exploring the Nature and Context of the Food Tongan Children Eat in Ha'apai Using Wearable Cameras. Int J Environ Res Public Health 2019; 16:ijerph16101681. [PMID: 31091717 PMCID: PMC6572351 DOI: 10.3390/ijerph16101681] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 05/05/2019] [Accepted: 05/07/2019] [Indexed: 11/21/2022]
Abstract
Unhealthy food consumption is a key driver of the global pandemic in non-communicable diseases (NCDs). The Government of Tonga has prioritised NCD prevention due to the very high rates of NCDs in the Kingdom. This research examines the nature and context of the me’akai (food) consumed by Tongan children in Ha’apai using wearable cameras. Thirty-six randomly selected 11-year-old children used wearable cameras to record their lives for three days, as part of the wider Kids’Cam Tonga project. Images were analysed to assess the participants’ food consumption according to a new data analysis protocol for Tonga. Core foods were defined as including breads and cereals, fresh fruit, vegetables, meat and alternatives, and staple vegetables. Non-core food types included confectionery, unhealthy snack foods, edible ices, and processed meat. Tongan researchers led the research in partnership with the Government of Tonga. Overall, children were observed to have consumed a mean of 4.5 (95% CI 3.3, 6.7) non-core and 2.3 (95% CI 1.8, 2.9) core foods per 10 h day, excluding mixed meals. Unhealthy snack foods, confectionary, and cookies, cakes, and desserts were the most commonly consumed non-core foods, and fresh fruit was the most frequently consumed core food. Snacking was the most frequent eating episode observed, with children snacking on non-core foods four times a day (95% confidence interval (CI) 2.5 to 6.2) compared to 1.8 (95% CI 1.3 to 2.6) core food snacks per day. Most commonly, children were observed eating at home, at school, and on the road while out walking. The most common sources of food were the home, other children, and the supermarket. On average, children consumed one purchased product per day, almost all (90%) of which were non-core. Children were also observed eating an average of just less than one mixed meal per day. Less than half (45.2%) of all mixed meals observed were traditional foods. This research illustrates the presence, and likely dominance, of energy-dense nutrient-poor (EDNP) foods in the diet of these Tongan children. It highlights a transition from a traditional diet and suggests that these children live in an obesogenic environment, one that promotes obesity as a normal response to an abnormal environment. The findings support efforts by the Government of Tonga for the implementation of a healthy School Food Policy, junk food taxes, and initiatives to ban the importation of EDNP foods. This study has relevance for other Pacific Island nations and all nations concerned with addressing obesity and other diet-related NCDs.
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Affiliation(s)
- Loma Veatupu
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Viliami Puloka
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Moira Smith
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Christina McKerchar
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
| | - Louise Signal
- Health Promotion & Policy Research Unit, University of Otago, Wellington 6242, New Zealand.
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Vandevijvere S, De Ridder K, Fiolet T, Bel S, Tafforeau J. Consumption of ultra-processed food products and diet quality among children, adolescents and adults in Belgium. Eur J Nutr 2019; 58:3267-78. [DOI: 10.1007/s00394-018-1870-3] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2018] [Accepted: 11/23/2018] [Indexed: 01/17/2023]
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