全球粮食安全与营养论坛 (FSN论坛)

  1. Which policies and/or programmes have been implemented in your country or region to prevent overweight and obesity?
  1. Which of the policies and/or programmes mentioned before have succeeded in reducing overweight and obesity levels? Please complete your answer answering the following queries:
  • What was the target population?

Most of the strategies have aimed to the general population but there has been a special emphasis on children, for both ethical and economical reasons, i.e. these strategies are more cost-effective by its own nature than those aimed to adults, simply because the duration of the positive effects is expected to last longer. Additionally, children's preferences are thought to be more modifiable than those from the adult populations.

  • In which way were results assessed and/or effectiveness determined? What were the success factors that contributed to the effectiveness?

Generally speaking, the epidemiological data -overweight and obesity prevalence- is the one used to determine the success of the strategies. However, in the case of the sugary drink tax, the emphasis has been on economical data reflecting household expenditure and beverages sales. In my opinion, there is no way to account any of this strategies as a success. There is no way yet to link the economical data to the epidemic data.

  • What were the main challenges, constraints and lessons learned?

The National Public Health Institute (INSP) has published a preliminary report  stating that the tax has decreased sugary drinks consumption specially among the poorest. A few months later, a new report was published confirming this data. Logically, the tax supporters used the INSP message as evidence to state that the sugar tax is a significant success. 

However, the study itself mentions a very interesting fact that curiously enough, has been absent in all the related public communications from the INSP: The household expenditure has not decreased accordingly. There is no savings from the families, and this fact cannot be attribuited to replacing taxed sugary drinks with bottled water. 

In another study by some of the researchers involved in the INSP study, it is described how the industry has reacted and adapted its strategies to the taxation. Actually both studies conclude that more research is needed in order to find out if the sugary drinks tax is really working or not. 

So, if the goal of the tax was somehow to minish the sales of sugary drinks, it may have been succesful. However, if the goal of the tax was to reduce overweight and obesity, there is no evidence to conclude anything. As I state it in the Iberoamerican Development Bank's blog, a reduction in sugary drink consumption does not necessarily mean obesity reduction. Thinking in such a linear way causes to overlook that people may be substituting these products with other equally harming, specially if we consider the possibility of a compensation behavior derived from a "halo effect". That means that some people giving up a sugary drink, e.g. having a healthy-imposed-behavior, may think they are entitled to having an extra dessert because they are being healthy anyway...In addition, having an extra dessert, could trigger the "what the hell effect", which is a temporary lost of control. This could end up in people having not an extra dessert but having several extra treats during the day, possibly explaining the lack of savings by giving up a sugary drink. 

Of course, it could be also simpler. People could be substituting the now more expensive sugary drinks by cheaper treats or products. Specially under the reaction of the food and beverages industry.

  1. Finally, which ELEMENTS ARE CRUCIAL to effectively support policies, strategies and/or programs targeting overweight and obesity reduction?
  • ​First of all, we must revise the cause of obesity. The calorie balance concept cannot be used to explain fat generation (or adipogenesis) wihtout risking inefficiency and redundancy. If we do not know what really causes obesity we cannot create efficient strategies. We will spend thousands of resources treating the symptoms and possibly reinforcing the causes. I am currently working in a discussion paper in this matter, explaining why calorie balance is not useful and what could we do instead of using it. If somebody is interested, we can discuss it further. 
  • We have to take in consideration people's behavior, biases and particular heuristics in every policy or intervention
  • we have to try to forecast the consequences of the public policies from the main stakeholders and reduce the risks of being undermined by their reactions
  • Governments have to stop thinking in linear ways They have to notice that the whole food value chain is interconnected, from the incentives that the farmers have to plant one or another seed to what the final consumer decides to cook for dinner. 

Thanks for reading this. I look forward to hearing back from you.

Salvador