Policies to curb unhealthy beverages abound. How do policymakers choose?

Research has long shown that sugary beverages – sodas, juices, sports drinks, sweetened coffees and more – are closely associated with adverse health outcomes such as heart disease, diabetes and obesity, and their consumption and popularity increased dramatically during the last half of the 20th century.

Multiple countries have enacted policies to help reduce the prevalence of sugar-sweetened beverages (SSBs) in the diet, and a new review in the Annual Review of Public Health outlines the impacts these policies are having around the world.

Shu Wen Ng, PhD, Distinguished Scholar in Public Health Nutrition at the UNC Gillings School of Global Public Health and the Global Food Research Program at UNC, is co-author of “Sugar-Sweetened Beverage Reduction Policies: Progress and Promise,” published April 1, 2021, with co-authors from the University of Washington, Harvard University and the American Heart Association.

Their review presents a framework illustrating the various types of financial, information, default and availability policies that have been used to reduce SSB exposure and consumption and introduces how considerations such as feasibility, impact and equity crosscut those policies.

Financial policies include the increase of price on SSBs, taxes, restrictions on price or promotions and incentives for the purchase of healthy beverages (e.g, plain milks and water).

  • SSB taxes are one of the most effective policies for SSB reduction with seven US cities and more than 40 nations across the globe having adopted SSB taxes as of August 2020. Evidence shows that they not only increase the prices of SSBs, but they also reduce purchases of those beverage. Though opponents have claimed that these taxes result in job losses, research has not yet found this to be true.

Information policies, such as warning labels on packages or advertising restrictions, reduce the public’s exposure to SSB marketing and / or increase awareness of their health risks.

  • Front-of-package warning labels on SSBs can indicate the presence and amount of harmful ingredients, like excess sugar, or describe their negative health outcomes, like type 2 diabetes, to influence consumer behavior. More than 40 countries have implemented voluntary or mandatory warning labels. A simulation study of a U.S. national mandatory SSB health warning policy found that it would reduce average SSB intake by 25.3 calories per day and total energy intake by 31.2 calories per day.

Default policies, such as including a healthy drink in kids’ restaurant meals, make the choice of a healthy beverage automatic.

  • When restaurants bundle SSBs with kids’ meals or make them the default option, the likelihood of consuming SSBs when eating out increases. An analysis of kids’ meals at large U.S. chain restaurants shows that substituting a lower-calorie beverage (e.g., water) for a sugary drink in the U.S. would reduce calories in a default meal by 100 calories and 20 grams of sugar. Some restaurants have made voluntary pledges to offer healthier beverages as the default option in these meals and a handful of state and local governments in the U.S. have passed laws to improve the healthfulness of beverages in children’s meals.

Availability policies decrease access to SSBs or reduce portion sizes through beverage procurement policies or product placement of both SSBs and healthy beverages.

  • Recent policy actions have limited access to SSBs in federal nutrition programs, which could affect millions of Americans. Though research on availability policies is limited, one simulation study indicated that restricting SSB purchases in SNAP (Supplemental Nutrition Assistance Program), could reduce consumption by an average of 24 calories per person per day, cutting the prevalence of obesity and diabetes over time, and save money in the long-run.

When determining which policy approach or combination of approaches is appropriate, policymakers should consider whether those choices will be equitable, impactful, and feasible given the context.

“With the pandemic and the resultant shifts in where children and adults are eating and exposed to unhealthy food marketing, emphasis on policies outside of school settings such as around digital and TV marketing may be more critical now than before,” says Ng.

The co-authors note that no single policy will reduce SSB consumption to healthy levels. Rigorous policy evaluation ­– like the work of researchers at GFRP – can support effective policies and discourage ineffective policies.