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Expected changes in obesity after reformulation to reduce added sugars in beverages: A modeling study.
PLoS Med. 2018 10; 15(10):e1002664.PM

Abstract

BACKGROUND

Several strategies have been proposed to reduce the intake of added sugars in the population. In Mexico, a 10% sugar-sweetened beverages (SSBs) tax was implemented in 2014, and the implementation of other nutritional policies, such as product reformulation to reduce added sugars, is under discussion. WHO recommends that all individuals consume less than 10% of their total energy intake (TEI) from added sugars. We propose gradually reducing added sugars in SSBs to achieve an average 10% consumption of added sugars in the Mexican population over 10 years and to estimate the expected impact of reformulation in adult body weight and obesity.

METHODS AND FINDINGS

Baseline consumption for added sugars and SSBs, sex, age, socioeconomic status (SES), height, and weight for Mexican adults were obtained from the 2012 Mexico National Health and Nutrition Survey (ENSANUT). On average, 12.6% of the TEI was contributed by added sugars; we defined a 50% reduction in added sugars in SSBs over 10 years as a reformulation target. Using a dynamic weight change model, sugar reductions were translated into individual expected changes in body weight assuming a 43% caloric compensation and a 2-year lag for the full effect of reformulation to occur. Results were stratified by sex, age, and SES. Twelve years after reformulation, the TEI from added sugars is expected to decrease to 10%, assuming no compensation from added sugars; 44% of the population would still be above WHO recommendations, requiring further sugar reductions to food. Body weight could be reduced by 1.3 kg (95% CI -1.4 to -1.2) in the adult population, and obesity could decrease 3.9 percentage points (pp; -12.5% relative to baseline). Our sensitivity analyses suggest that the impact of the intervention could vary from 0.12 kg after 6 months to 1.52 kg in the long term.

CONCLUSIONS

Reformulation to reduce added sugars in SSBs could produce large reductions in sugar consumption and obesity in the Mexican adult population. This study is limited by the use of a single dietary recall and by data collected in all seasons except summer; still, these limitations should lead to conservative estimates of the reformulation effect. Reformulation success could depend on government enforcement and industry and consumer response, for which further research and evidence are needed.

Authors+Show Affiliations

National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico.National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico.National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico.National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico.Department of Nutrition, University of North Carolina Gillings School of Global Public Health, Carolina Population Center, Chapel Hill, North Carolina, United States of America.National Institute of Public Health, Cuernavaca, Mexico.University Center of Los Altos, Tepatitlan de Morelos, University of Guadalajara, Guadalajara, Jalisco, Mexico.National Institute of Public Health, Center for Population Health Research, Cuernavaca, Mexico.

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

30289898

Citation

Basto-Abreu, Ana, et al. "Expected Changes in Obesity After Reformulation to Reduce Added Sugars in Beverages: a Modeling Study." PLoS Medicine, vol. 15, no. 10, 2018, pp. e1002664.
Basto-Abreu A, Braverman-Bronstein A, Camacho-García-Formentí D, et al. Expected changes in obesity after reformulation to reduce added sugars in beverages: A modeling study. PLoS Med. 2018;15(10):e1002664.
Basto-Abreu, A., Braverman-Bronstein, A., Camacho-García-Formentí, D., Zepeda-Tello, R., Popkin, B. M., Rivera-Dommarco, J., Hernández-Ávila, M., & Barrientos-Gutiérrez, T. (2018). Expected changes in obesity after reformulation to reduce added sugars in beverages: A modeling study. PLoS Medicine, 15(10), e1002664. https://doi.org/10.1371/journal.pmed.1002664
Basto-Abreu A, et al. Expected Changes in Obesity After Reformulation to Reduce Added Sugars in Beverages: a Modeling Study. PLoS Med. 2018;15(10):e1002664. PubMed PMID: 30289898.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Expected changes in obesity after reformulation to reduce added sugars in beverages: A modeling study. AU - Basto-Abreu,Ana, AU - Braverman-Bronstein,Ariela, AU - Camacho-García-Formentí,Dalia, AU - Zepeda-Tello,Rodrigo, AU - Popkin,Barry M, AU - Rivera-Dommarco,Juan, AU - Hernández-Ávila,Mauricio, AU - Barrientos-Gutiérrez,Tonatiuh, Y1 - 2018/10/05/ PY - 2018/04/19/received PY - 2018/08/31/accepted PY - 2018/10/6/entrez PY - 2018/10/6/pubmed PY - 2019/4/10/medline SP - e1002664 EP - e1002664 JF - PLoS medicine JO - PLoS Med VL - 15 IS - 10 N2 - BACKGROUND: Several strategies have been proposed to reduce the intake of added sugars in the population. In Mexico, a 10% sugar-sweetened beverages (SSBs) tax was implemented in 2014, and the implementation of other nutritional policies, such as product reformulation to reduce added sugars, is under discussion. WHO recommends that all individuals consume less than 10% of their total energy intake (TEI) from added sugars. We propose gradually reducing added sugars in SSBs to achieve an average 10% consumption of added sugars in the Mexican population over 10 years and to estimate the expected impact of reformulation in adult body weight and obesity. METHODS AND FINDINGS: Baseline consumption for added sugars and SSBs, sex, age, socioeconomic status (SES), height, and weight for Mexican adults were obtained from the 2012 Mexico National Health and Nutrition Survey (ENSANUT). On average, 12.6% of the TEI was contributed by added sugars; we defined a 50% reduction in added sugars in SSBs over 10 years as a reformulation target. Using a dynamic weight change model, sugar reductions were translated into individual expected changes in body weight assuming a 43% caloric compensation and a 2-year lag for the full effect of reformulation to occur. Results were stratified by sex, age, and SES. Twelve years after reformulation, the TEI from added sugars is expected to decrease to 10%, assuming no compensation from added sugars; 44% of the population would still be above WHO recommendations, requiring further sugar reductions to food. Body weight could be reduced by 1.3 kg (95% CI -1.4 to -1.2) in the adult population, and obesity could decrease 3.9 percentage points (pp; -12.5% relative to baseline). Our sensitivity analyses suggest that the impact of the intervention could vary from 0.12 kg after 6 months to 1.52 kg in the long term. CONCLUSIONS: Reformulation to reduce added sugars in SSBs could produce large reductions in sugar consumption and obesity in the Mexican adult population. This study is limited by the use of a single dietary recall and by data collected in all seasons except summer; still, these limitations should lead to conservative estimates of the reformulation effect. Reformulation success could depend on government enforcement and industry and consumer response, for which further research and evidence are needed. SN - 1549-1676 UR - https://www.unboundmedicine.com/medline/citation/30289898/Expected_changes_in_obesity_after_reformulation_to_reduce_added_sugars_in_beverages:_A_modeling_study_ L2 - https://dx.plos.org/10.1371/journal.pmed.1002664 DB - PRIME DP - Unbound Medicine ER -