Obesity: One Of The Leading Risks Of Global Deaths

Since the beginning of the new millennium, due to the increasing awareness regarding health and safety, the beverage companies are facing criticisms for impeding ways to a global epidemic named obesity. The changing legislatures worldwide is creating an even more difficult situation for them. Obesity and overweight are now considered one of leading cause of global deaths. In USA, 61% of the population are obese. One of the significant causes of this rising obesity rate is the food habit and the high sugar containing diet of the Americans. As USA is the largest and most popular market for sugary drinks, regulators are now implementing taxes on sugary beverages and promoting healthier lifestyles for the people. The tax and the raising awareness among people are causing a decline in the sales of the sugary beverages. The American Beverage Association and the beverage companies like Coca Cola and PepsiCo. are spending millions for advertising to boost up their sales and lobbying to repeal the taxes in cities worldwide. In this report, we have discussed the obesity, risk associated with obesity and the causes of it, childhood obesity, the food industry’s response to obesity, recent legislature changes and impose of soda taxes worldwide and the beverage companies’ response to these taxes and their responsibilities to the society as a whole.

Obesity refers to a medical condition in which excess body fat accumulated in the body may have negative impact on health. People with BMI more than 30 kg/m2 are considered obese whereas people with BMI 25-30 kg/m2 are generally considered overweight. Obesity is one of the leading preventable cause of death worldwide. In 2015, 600 million adults (12%) and 100 million children were obese in 196 countries . Obesity is more common in women than men. According to a report on obesity by CDC, among men, compared to the middle income group, obesity prevalence was lower in the lowest and highest income groups. This pattern was evident among non-Hispanic white and Hispanic men. For non-Hispanic black men, obesity was higher in the highest income group than the lowest income group. Among women, the pattern found was slightly different. Obesity prevalence was lower in the highest income group compared to the middle and lowest income group. This pattern was observed among non-Hispanic white, non-Hispanic Asian and Hispanic women. There was no significant difference in obesity prevalence by income among non- Hispanic black women.

Excessive body weight is associated with various health problems like cardiovascular disease, diabetes and different types of cancer. According to WHO, at least 2.8 million adults die each year due to obesity. Moreover, 44% of the diabetes, 23% of cardiovascular disease and 7%-41% of certain cancer (endometrial, breast, gall bladder and liver) are attributable to obesity. In recent times, death due to being overweight is more common than due to being underweight. In addition, obesity increases the risk of dyslipidemia, gallbladder disease, type 2 diabetes, osteoarthritis, body pain and difficulty with physical functioning, sleep apnea and breathing problem and mental illness such as clinical depression, anxiety and other mental disorder. Obesity and associated health problems have a significant impact on the US health care system. The medical care cost associated with obesity is increasing over the years, from $98 billion in 1998 to $147 billion in 2008. The annual nationwide productive costs of obesity obesity-related absenteeism range between $3.38 billion ($79 per obese individual) and $6.38 billion ($132 per obese individual).

Recent statistics are showing an alarming increase in the childhood obesity. This increase has been observed in all racial groups but in some ethic groups the increase is more prevalent. At present, almost 8% of the children aging 4-5 years are overweight. According a report by CDC, between NHANES I and II, the prevalence of obesity doubled in the children older than 6 years. Several studies have found that children who are overweight in their childhood or adolescent period are at higher risk of cardiovascular disease and dyslipidemia even if they lost weight in their adulthood. Childhood obesity is mostly associated with less physical activity and dietary habit.

Obesity is combination of causes and contributing factors like education and skills, food marketing and promotion. However, the most common cause of obesity are unhealthy dietary pattern and less physical activity. In USA, one of the major causes of obesity is unhealthy diet. A study by USDA shows that on an average, Americans consumed 20% more calories in the 2000s than in the 1980s. Another study by WHO revealed that eating fast food is correlated to obesity and almost 11% of the diet of Americans consisted of fast food and soft drinks. Lack of physical activity is also a major culprit in the obesity epidemic. Sedentary lifestyle, living in neighborhoods with scarce public transportation, increased tendency to drive rather than walk have added to the unhealthy lifestyle of the Americans. Other causes include medical conditions and antibiotic overuse.

The food industry in general has always faced criticism for being one of the prime factors contributing to obesity. Soft drinks have been the beverage of choice for most Americans. Sugary drinks, containing high fructose corn syrup, made up of 4% of daily calorie intake of Americans, which had risen to 9% by 2001 Before 50’s, standard soft drinks bottles were 6.5 oz. In 1950, 12 oz. cans were introduced which became widely available by 1960. By the early 90s, 20 oz. plastic bottles became the norm. At the same time, obesity and diabetes rose simultaneously. According to CDC report in 1999, 20% of the US adults were obese.

Though, in 1970s and 1980s, soft drinks were consumed more than water, in the new millennium, things were slightly different. In 2014, according to report published in Fortune, Coke had a decline in volume of sales by 1.1% and Pepsi saw a decline of 1.4%. On the contrary, sales volume across the entire beverage industry, including non-carbonated beverages and water increased by 1.7% in the same time frame. This indicates that consumers are now aware of the harmfulness of the carbonated drinks and seek for healthier alternatives, notably juices and flavored water which do not contain high calories and sugar as soda.

To counter the decline in profit, beverage companies like Coca Cola and Pepsi are now investing in healthier alternatives like water, coconut water, sports drinks, flavored milk and mid calorie colas sweetened with plant-based stevia. But low calorie soft drinks like Coca Cola Life was not quite successful in attracting customers. According to Fortune, a significant number of adults have cut back or do ot consume even low calorie carbonated drinks, with 18-34-year-old age bracket leading the group. There are also evidence of a rise in exercise and maintain a healthy lifestyle which has led to the decline in the number of diabetes cases from 1.7 million in 2008 to 1.4 million in 2014.

Obesity and Type II diabetes are the two major global public health concern in recent times. Recent studies have found positive correlation between sugary beverage intake and excess body weight. One sugary beverage intake per day on a persons’ diet amount to 15lbs of weight gain over the course of one year. Another growing concern in the health sector of many developed and developing countries is Type II diabetes. In 2015, 1.6 million deaths worldwide were due to this disease. As the sugar from beverage is an added sugar, not natural sugar, it overloads the pancreas and liver very quickly after entering the body and increase the risk of Type II diabetes and cardiovascular disease over time. Studies have shown that consuming one or two sugary drinks per day increases the risk of Type II diabetes by 26%.

The extreme availability of sugary beverages and their demand in the younger generation have made the public health professionals concerned. With a view to improve public health safety, sugary beverages are being under the tax provision in many countries worldwide. The very first country to impose tax on sugar sweetened beverage was Denmark in the 1930s. But unfortunately, recently it was abolished due to its fruitlessness. But it was Norway who has had a general ax on products containing refined sugar since 1922 and recently increased the tax by 42% but it was more inclined towards boosting state income rather than prohibiting sugar consumption. Hungary has imposed a 4 cent tax on food and drinks containing high amount of sugar since 2011. In a recent study, it was found that in 2016, 19% of the people have reduced their consumption of soft drinks.

France first introduced soda tax in 2012. The tax targeted both drinks with added sugar and drinks with artificial sweeteners. As an effect of the tax, sugary drinks were supposed to be 3.5% more expensive. In 2016, a study by Mazzochi, a professor at the department of statistical sciences at the University of Bologna showed that after the tax implementation, the consumption of the taxed drinks was reduced by 9 centiliters per week per person. Mexico, with one of the highest rates of obesity in the world, proposed a 10% tax on carbonated drinks in 2010 in order to improve the public health condition. But it was opposed by the soda manufacturers stating that it will lead to higher unemployment. After negotiation, 1 MXN per liter tax on soda was imposed. According to a study published in British Medical Journal, a 95 decrease in the consumption of soda was seen. The UAE imposed 50% tax on soft drinks and 100% tax on energy drinks on October 2017 to cut back the consumption of sugary beverages.

The United Kingdom introduced a sugar tax named “Soft Drinks Industry Levy” in their 2016 budget on the production and importation of sugary beverages excluding milk and pure fruit juice. The tax has come into effect on April 2018 but was criticized for its partial taxation rules by different classes of people. Philippines has included the sugar sweetened tax in their tax reform in December 2017 which will come into effect from December 2018. This tax excluded all kinds of milk, ground and 3-in-1 coffee packs and 100% pure fruit and vegetable juice. South Africa and Ireland both introduced soda tax in 2018 whereas the Australian Beverages Council have proposed reduction in sugar in beverages by 2025 in order to avert soda tax. But not all countries are successful in introducing a sugar tax on beverages. For example, in Columbia, a proposal for 20% tax on sugary beverages was turned down by the Columbian legislature due to popularity of carbonated beverages.

Being the largest market of soft drinks alone, there was always a concern for the public health safety in the US. Several studies have confirmed that excess amount of sugar intake in the diet is the prime of increasing obesity in the US. Though US does not have any nationwide soda/sugar tax but different stated have imposed different levels of soda tax in order to promote a healthier lifestyle to its residents. The initial sugar taxes dated back to the 1950’s but initial sugar taxes were imposed mostly on manufacturers and distributors. The older taxes exist mainly in the Southeastern United States.

West Virginia: this was one of the pioneer states to impose a tax on sugary drinks. Since 1950, West Virginia has imposed a tax on bottled soft drinks as well as syrups required to make soft drinks that are manufactured or distributed in West Virginia. This tax was primarily enacted to finance a school of medicine and nursing at the West Virginia university.

Alabama: Since 1975, Alabama has imposed a licensing tax on people involved in the manufacturing or selling of soft drinks including fruit juice and flavored milk.

Virginia and Tennessee: Virginia (since 1984) and Tennessee (since 1987) have imposed sugar tax on wholesalers and distributors and manufacturers, sellers and importers based on gross receipts of sales. Both of the state’s sugar tax fund go to the litter control fund.

Arkansas: Since 1992, Arkansas has imposed a tax on the manufacturers and distributors of soft drinks including coffee, tea and fruit juices containing 10% of sugar. The tax proceeds go to the Arkansas Medicaid Fund.

Washington: Since 2009, Washington has imposed tax on the volume of syrup sold to produce soft drinks in the state.

While the older taxes are imposed with a view to financing some programs, the newer soda taxes are solely intended to reduce the sugar consumption of the people and to promote a healthier lifestyle. One of the pioneer of the newer soda tax was New York City. Though it did not impose any tax on soft drinks, but in 2012, it banned soft drinks sized more than 16fl.oz. Though the intention was to curb the sugar consumption of the people, it faced heavy criticism from NAACP and Hispanic Federation for being against civil rights and the Mayor and the city was sued by American Beverage Association. Eventually legislatures focused on imposing tax on sugary drinks rather than restricting sizes.

After the statewide tax proposal stalled for several times, the city level taxation was passed and Berkley, CA was the first city in the United States to have a penny-per-ounce tax on sugar sweetened drinks in 2014 followed by Albany, Oakland and San Francisco in the same year. The term sugar-sweetened beverage defined in this jurisdiction as a beverage having at least two calories/fl.oz. for Berkley and Albany and 25 or more calories per 12fl.oz beverages for Oakland and San Francisco. The tax proceeds generated by Berkley was promised to be used for creating garden and other healthy initiatives. In a 2016 survey it was found that consumption of sugary beverages reduced by 21% in the low income neighborhood of Berkley and this tax collected $1.3 million for public health sectors.

The biggest soda tax was proposed by Philadelphia, raising a soda price three cents per ounce. But this proposal faced severe opposition from the beverage industry. The beverage industry argued that it would affect the poor adversely. The American Beverage Industry spent $1.3 million in 2016 for lobbying against the proposal whereas the medical and public health groups including the American Medical Association and the American Heart Association supported the proposal. Finally, a revised proposal was passed with a 1.5 cents per oz. tax on soft drinks including diet drinks. Which came into effect from January 1,2017. The tax proceedings are intended to pay for pre-K programs, government employee benefits and rebuilding parks and other recreation center. A recent study showed that post implementation of the tax, sugary beverage consumption reduced to 1.3 beverages/week per person.

Boulder, Colorado has the highest soda tax rate among all the cities with 2 cents per ounce soda tax. The tax came into effect on July,2017 and the proceedings will be used for health promotions and other wellness program.

The one cent per ounce tax imposed by Cook County, Illinois jurisdiction on November 2016 was one of the most popular jurisdictions of the US but unfortunately the tax was revoked as it was intended more to cover the city’s budget deficit rather than improving health conditions.

But there are some different scenarios in some other cities as well. For example, Santa Fe, New Mexico rejected a soda tax, whereas Michigan enacted a state law which prohibits local governments to impose a soda tax and in Chicago county commissioners are repealing their soda tax. But overall, the consumption of sugar sweetened beverages has fallen which may be credited to the soda tax impose by cities and increasing public awareness.

Reference:

“Obesity and Overweight.” World Health Organization, World Health Organization, www.who.int/en/news-room/fact-sheets/detail/obesity-and-overweight.
“Health Effects of Overweight and Obesity in 195 Countries over 25 Years.” New England Journal of Medicine, vol. 377, no. 1, June 2017, pp. 13–27., doi:10.1056/nejmoa1614362
“Coca-Cola Confronts Soda Taxes and a Changing Regulatory Environment.”
Finkelstein, Eric A., et al. “Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates.” Health Affairs, vol. 28, no. 5, 2009, doi:10.1377/hlthaff.28.5.w822.
Trogdon, J. G., et al. “Indirect Costs of Obesity: a Review of the Current Literature.” Obesity Reviews, vol. 9, no. 5, May 2008, pp. 489–500., doi:10.1111/j.1467-789x.2008.00472.x.
Writers, Staff. “Obesity in America | Who Is Affected?” PublicHealth.org, PublicHealth.org, www.publichealth.org/public-awareness/obesity/affected/.
“Sugary Drinks and Obesity Fact Sheet.” The Nutrition Source, 26 May 2015, www.hsph.harvard.edu/nutritionsource/sugary-drinks-fact-sheet/.
Tavernise, Sabrina. “New Diabetes Cases, at Long Last, Begin to Fall in the United States.” The New York Times, The New York Times, 1 Dec. 2015, www.nytimes.com/2015/12/01/health/new-diabetes-cases-at-long-last-begin-to-fall-in-the-united-states.html.
Malik, Vasanti S, et al. “Intake of Sugar-Sweetened Beverages and Weight Gain: a Systematic Review.” The American Journal of Clinical Nutrition, vol. 84, no. 2, Jan. 2006, pp. 274–288., doi:10.1093/ajcn/84.2.274.
Malik, Vasanti S., et al. “Sugar Sweetened Beverages and Risk of Metabolic Syndrome and Type II Diabetes: a Meta Analysis.” Current Neurology and Neuroscience Reports., U.S. National Library of Medicine, Nov. 2010, www.ncbi.nlm.nih.gov/pmc/articles/PMC2963518/.
“Sugary Drink Tax.” Wikipedia, Wikimedia Foundation, 18 Sept. 2018, en.wikipedia.org/wiki/Sugary_drink_tax.
“Soda Taxes: Old and New.” The Tax Adviser, 1 June 2017, www.thetaxadviser.com/issues/2017/jun/soda-taxes.html.