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National taxation on sugar-sweetened beverages and its association with overweight, obesity, and diabetes

National taxation on sugar-sweetened beverages and its association with overweight, obesity, and diabetes

The article presents a systematic scoping review following the Preferred Reporting Items for Systematic reviews and Meta-Analyses extension for Scoping Reviews to summarize the landscape of national tax laws on sugar-sweetened beverage (SSB) – soft drinks, include carbonated and noncarbonated beverages that contain sugar-based caloric sweeteners, such as sucrose, high-fructose corn syrup, or fruit juice concentrates –  consumption and its associated health risks, encompassing weight gain, obesity, type 2 diabetes, and cardiovascular disease. Its primary aim is to provide a methodical overview of national tax regulations on SSBs and to assess their influence on the prevalence of overweight, obesity, and type 2 diabetes.

The protocol of the review has been registered in the International Prospective Register of Systematic Reviews, registration number CRD42021233309.

Results indicate that 53 countries have instituted taxes on SSBs, each with unique tax structures and rates. The predominant design involves amount-specific taxes contingent on the beverage volume. Additionally, the study furnishes data on the tax levy per liter of product across diverse countries and income brackets. Moreover, the article presents findings from a time series analysis scrutinizing the association between SSB taxation laws enacted up to 2013 and the prevalence of overweight, obesity, and type 2 diabetes among adults in various nations. A time series analysis was performed to assess if any statistically significant change in the trends of chosen indicators occurred after the intervention, with P values < 0.05 considered statistically significant. Time series analysis has been applied in the evaluation of the real-world effects of policies, since in this context randomization is typically not feasible. Unlike pre-post studies, time series studies allow for the use of the pre-existing trend as a control, hence evaluating the potential change of the trend of a specific indicator after the introduction of an intervention (e.g., a law) using the pre-intervention trend as a comparator. The indicates that some countries witnessing substantial shifts in the trends of these health indicators post-implementation of SSB taxation.

Authors involved in the 4P-CAN Project:

  • Dr. Leonardo Villani, MD, specialised in hygiene, preventive medicine, and public health, holding a Ph.D. in Basic Biomedical Sciences and Public Health. He serves as an Assistant Professor in these fields at Università Cattolica del Sacro Cuore (UCSC) in Rome. His research focuses on the epidemiology of infectious diseases, vaccination, and understanding the knowledge and attitudes of both the general population and healthcare professionals. Additionally, his work covers environmental health, planetary health, antimicrobial resistance, and healthcare-associated infections. Dr. Villani collaborates also with Policlinico Universitario Fondazione Agostino Gemelli- IRCCS (FPG) in Rome.
  • Dr. Roberta Pastorino obtained her Ph.D. in Biomedical Statistics from the University of Milan in 2010 and a Master’s degree in Molecular and Genetic Epidemiology from the University of Pavia in 2012. Currently serving as an Assistant Professor at Università Cattolica del Sacro Cuore (UCSC) in Rome, she specializes in biomedical statistics, molecular and genetic epidemiology, and biomedical engineering. Her research focuses on medical statistics, public health genomics, and personalized medicine to enhance healthcare sustainability. Dr. Pastorino actively participates in numerous national and international projects related to personalized medicine and prevention, taking on leadership roles and contributing to recommendations for their integration into EU healthcare systems. She is also the President of the “Public Health Genomics” section of the European Public Health Association (EUPHA) and has been honoured with the 2nd Best Practice Award in Personalised Medicine from the International Consortium of Personalised Medicine of the EU Framework Programme (H2020) in 2019. Her work has been published in esteemed journals such as the European Journal of Public Health, Circulation, and the Journal of Personalized Medicine. Dr. Pastorino collaborates also with Policlinico Universitario Fondazione Agostino Gemelli- IRCCS (FPG) in Rome.
  • Prof. Stefania Boccia is a Full Professor of Hygiene, Preventive Medicine, and Public Health at Università Cattolica del Sacro Cuore (UCSC) in Rome, and also Deputy Research Director at Fondazione Policlinico Universitario A. Gemelli- IRCCS (FPG) in Rome, and member of the UCSC Gender Equality Plan (GEP). Additionally, she is affiliated with the Meta Research Center at Stanford University, USA. With a distinguished career, Prof. Boccia has served as President of the Woman Health Center for Digital and Personalized Medicine at UCSC and as President of the “European Public Health Epidemiology Section” of the European Public Health Association (EUPHA). She has earned global recognition, ranking among the world’s top 2% scientists according to Stanford University. Prof. Boccia’s research interests encompass personalized medicine, healthcare policies, and prevention strategies, with extensive publications and projects funded by the European Commission and Italian Ministry of Health. She coordinates several national and international projects such as IC2PerMed, PROPHET, and EXaCT, and participates as a partner in numerous others including Can.Heal, ECHoS, 4P-CAN, GDI, and PERCH. Moreover, Prof. Boccia is Editor for the European Journal of Public Health, Associate Editor for the European Journal of Epidemiology, and Advisory Board Member for Lancet Regional Health- Europe.

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