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To Tax or Not to Tax Sugary Drinks? This Is the Question

Silano, Marco*; Agostoni, Carlo

Journal of Pediatric Gastroenterology and Nutrition: October 2017 - Volume 65 - Issue 4 - p 360
doi: 10.1097/MPG.0000000000001622

*Unit of Human Nutrition and Health, Department of Food Safety, Nutrition and Veterinary Public Health, Istituto Superiore di Sanità

Pediatric Intermediate Care Unit, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, DISCCO, Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy.

Address correspondence and reprint requests to Marco Silano, MD, Unit of Human Nutrition and Health, Istituto Superiore di Sanità, Viale Regina Elena, 299 Rome 00161, Italy (e-mail:

Received 8 February, 2017

Accepted 20 April, 2017

C.A. received fees from SOREMARTEC Italia for lectures and presentations at courses and congresses, not related to this specific topic. M.S. reports no conflicts of interest.

See “Why Tax Sugar Sweetened Beverages?” by Hashem and Rosborough on page 358.

In the last months, several countries and cities have adopted a tax on sugary drinks as an action to tackle childhood obesity; Mexico, the city of Berkeley in California, USA, and last, the UK levy on manufacturers to be implemented from April 2018, are some of the cases (1–3). In addition to the economic aspects, we here raise concerns about the use of a “sugar tax” to correct the unbalanced dietary habits of the population, even if this intervention is framed in multidisciplinary strategy to combat the raising rates of adiposity excess in children.

As a first point, is the presence of added or free sugar a sufficiently comprehensive criterion to determine what beverages should be taxed? We recognize that sugar-sweetened beverages (SSBs) are the main dietary source of free sugars, whereas they have no nutritional value (the so-called empty calories). An excess of consumption of fruit juices, because of their content of the naturally occurring fructose, may, however, have worst metabolic effects on intrahepatic fat accumulation and development of nonalcoholic fatty liver disease (4). Equally important, if not more so, does it sound reasonable to tax SSBs and not to consider for this type of intervention the sugar added to energy-dense snacks, biscuits, and cakes?

Secondly, the introduction of a sugar tax usually passes along to the consumers and the retail price increase is greater for the small packages and cans (5). So, it is predictable that the lower-income groups are most heavily affected by the taxes on sodas and SSBs. It has been argued that the prevalence of obesity is rising especially among lower social classes and the policies to tackle obesity should be addressed mostly towards these groups (6). We could, however, run the risk that socially and economically disadvantaged individuals shift the dietary choices towards cheaper and not healthier substitutes, such as the untaxed sugar-free artificially sweetened “light” version of sodas or, even, reduce the consumption of fresh fruits and vegetables to save money for the purchase of sodas. We also wonder whether it is ethical to promote a public health intervention that may disproportionately affect people, according to their income.

Cross-border shopping is another issue. The Danish tax put in 2012 on saturated fat is a well-documented example. During the period that tax was implemented in Denmark, Danes used to drive some distance across the border to buy butter, margarine and high-fat snacks in Germany, where these food were cheaper, because not subjected to the tax (7). Similarly, the sugar tax on drinks imposed very recently in the City of Berkeley, CA, was associated with a 20% reduction in the sale of sodas in the city where the tax is current, but in the same period, the sales of sodas have increased by 4% in the surrounding cities of San Francisco and Oakland (8).

Finally, there are no data showing that a reduction of soda sales implicates a corresponding reduction of consumption by children. It cannot be ruled out that the reduction of soda sales correlates with a reduction in consumption by adults in the family (9).

We believe that other interventions based on increasing the knowledge of general population about the health consequence of the consumption of SSBs may be effective in tackling childhood obesity, in addition to being more accepted by the citizens. Educational program, traffic light or teaspoon labelling and the indication on the label of the physical activity required to work out the energy assimilated with each serving of sodas are some examples of these interventions (10,11). The Italian experience has shown us that the food industry may be convinced to reduce the sugar content in sodas and snack foods with a mutual agreement with the governments (12), rather than forced by the imposition of a levy. SSBs are relatively easy to reformulate and it is likely that a progressive, 5% per annum reduction of sugar content would barely affect the taste of the product. Finally, to remain in the field of food taxation, it may be worthy trying a reduction of the taxes on fresh fruit, vegetables, and other healthy foods, rather than taxing the SSBs.

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© 2017 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,