Averting Obesity and Type 2 Diabetes in India Through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study

Basu, Sanjay , Vellakkal, Sukumar , Agrawal, Sutapa, Stuckler, David, Popkin, Barry M. and Ebrahim, Shah , Averting Obesity and Type 2 Diabetes in India Through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study, PLOS Medicine, January 2014

Posted: 6 Mar 2014

See all articles by Sanjay Basu

Sanjay Basu

Stanford University - Center for Primary Care and Outcomes Research and Center for Population Health Sciences; Harvard University - Center for Primary Care

Sukumar Vellakkal

Public Health foundation of India (PHFI)

Sutapa Agrawal

Public Health Foundation of India

David Stuckler

University of Cambridge - Faculty of Human, Social, and Political Science

Barry M. Popkin

University of North Carolina (UNC) at Chapel Hill - Carolina Population Center

Shah Ebrahim

Public Health Foundation of India

Date Written: January 7, 2014

Abstract

Background Taxing sugar-sweetened beverages (SSBs) has been proposed in high-income countries to reduce obesity and type 2 diabetes. We sought to estimate the potential health effects of such a fiscal strategy in the middle-income country of India, where there is heterogeneity in SSB consumption, patterns of substitution between SSBs and other beverages after tax increases, and vast differences in chronic disease risk within the population.

Methods and Findings Using consumption and price variations data from a nationally representative survey of 100,855 Indian households, we first calculated how changes in SSB price alter per capita consumption of SSBs and substitution with other beverages. We then incorporated SSB sales trends, body mass index (BMI), and diabetes incidence data stratified by age, sex, income, and urban/rural residence into a validated microsimulation of caloric consumption, glycemic load, overweight/obesity prevalence, and type 2 diabetes incidence among Indian subpopulations facing a 20% SSB excise tax. The 20% SSB tax was anticipated to reduce overweight and obesity prevalence by 3.0% (95% CI 1.6%–5.9%) and type 2 diabetes incidence by 1.6% (95% CI 1.2%–1.9%) among various Indian subpopulations over the period 2014–2023, if SSB consumption continued to increase linearly in accordance with secular trends. However, acceleration in SSB consumption trends consistent with industry marketing models would be expected to increase the impact efficacy of taxation, averting 4.2% of prevalent overweight/obesity (95% CI 2.5–10.0%) and 2.5% (95% CI 1.0–2.8%) of incident type 2 diabetes from 2014–2023. Given current consumption and BMI distributions, our results suggest the largest relative effect would be expected among young rural men, refuting our a priori hypothesis that urban populations would be isolated beneficiaries of SSB taxation. Key limitations of this estimation approach include the assumption that consumer expenditure behavior from prior years, captured in price elasticities, will reflect future behavior among consumers, and potential underreporting of consumption in dietary recall data used to inform our calculations.

Conclusion Sustained SSB taxation at a high tax rate could mitigate rising obesity and type 2 diabetes in India among both urban and rural subpopulations.

Keywords: tax, sugar-sweetened beverages, obesity, diabetes, economic-epidemiologic modeling, India

JEL Classification: l12, l18

Suggested Citation

Basu, Sanjay and Vellakkal, Sukumar and Agrawal, Sutapa and Stuckler, David and Popkin, Barry M. and Ebrahim, Shah, Averting Obesity and Type 2 Diabetes in India Through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study (January 7, 2014). Basu, Sanjay , Vellakkal, Sukumar , Agrawal, Sutapa, Stuckler, David, Popkin, Barry M. and Ebrahim, Shah , Averting Obesity and Type 2 Diabetes in India Through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study, PLOS Medicine, January 2014. Available at SSRN: https://ssrn.com/abstract=2404891

Sanjay Basu (Contact Author)

Stanford University - Center for Primary Care and Outcomes Research and Center for Population Health Sciences ( email )

1070 Arastradero Road Office 282
Palo Alto, CA 94304
United States

Harvard University - Center for Primary Care ( email )

Cambridge, MA
United States

Sukumar Vellakkal

Public Health foundation of India (PHFI) ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

HOME PAGE: http://www.phfi.org

Sutapa Agrawal

Public Health Foundation of India ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

David Stuckler

University of Cambridge - Faculty of Human, Social, and Political Science ( email )

Cambridge, CB3 9DD
United Kingdom

Barry M. Popkin

University of North Carolina (UNC) at Chapel Hill - Carolina Population Center ( email )

CB# 8120, University Square
123 West Franklin St.
Chapel Hill, 27599-2524
United States

Shah Ebrahim

Public Health Foundation of India ( email )

4 Institutional Area
Vasant Kunj
New Delhi, Delhi 110070
India

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