Sugary drink sales plummeted after price increase, study says

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From Colombia to South Africa, France to India, governments around the globe are exploring whether taxes on sugar-sweetened beverages (SSB) might curb obesity rates. Do these fines actually work to prevent people from choosing sweet drinks? Adding a small fee to the price tag of SSB’s at one UK restaurant chain most likely contributed to a decline in their sales, according to a study (published Oct. 2017) in the Journal of Epidemiology & Community Health. Jamie’s Italian, a chain created by celebrity chef Jamie Oliver, launched its own health campaign in September 2015. Along with adding 10 pence (about 13 cents) per drink to SSB, the chain offered new lower-sugar beverages and redesigned its menus.

After the fee was introduced, the chain observed an 11% decline in the number of sugar-sweetened beverages sold per customer during the first 12 weeks, according to the researchers. Over a six-month period, after the levy was charged, the number of sugary drinks had declined by 9.3% per customer. “Sugar taxes are currently prevalent policies to curb obesity rates and improve population diet,” said Steven Cummins, senior author of the study and a professor of population health at the London School of Hygiene & Tropical Medicine. “There’s actually very little evidence that they work in practice. There’s only a couple of studies that assess the impact of these kinds of (taxes) in real life on real customers.” Cummins and his colleagues analyzed Jamie’s Italian health campaign to add to this knowledge base.

‘Fat man of Europe’

Drinking sugar-sweetened beverages, including non-diet sodas, flavored juices, and some sports drinks, is associated with obesity, type 2 diabetes, cardiovascular disease, and cavities. In the UK, sugar-sweetened drinks may account for half of the excess calories consumed per day by children (two-thirds by U.S. children) while one in four British adults (one in three U.S.) are obese, according to a 2013 report from the United Nations.  The same report also found that obesity rates among adults have more than tripled in the past three decades. In 2015, the National Health Service made public its worries that the UK has become the “fat man of Europe.” Shortly after that, Jamie’s Italian decided, according to its website, to “raise awareness of how much sugar is present in certain soft drinks and make people think about their sugar intake, particularly that of their children” by adding 10 pence to the price tag.
Any profits raised by the fee were to be donated to The Children’s Health Fund in support of programs aimed at improving children’s health and food education, the campaign made clear. Cummins said he and his colleagues “had no control over the design or delivery” of Jamie’s Italian health intervention. Independently, the restaurant chain created and implemented the fee, made changes to its menu to explain the new price, introduced fruit spritzers (fruit juice mixed with water) and created promotional materials. “Jamie Oliver also broadcasted an hourlong documentary just a few days before the levy was introduced,” Cummins added. “So there was quite a lot of media coverage.”
The price increase can be seen as a complex “intervention” including a financial element in combination with non-fiscal components, the researchers said. Analyzing sales data from before and after the intervention, Cummins and his colleagues calculated the average number of sugar-sweetened beverage sales per customer in 37 Jamie’s Italian restaurants. In the 12 months prior, a total of 2,058,581 non-alcoholic beverages were sold in the restaurants, and 38% (775,230) of them were sugar-sweetened drinks. Adding a 10-pence fee to SSB was associated with significant declines (11.04%) in sales per customer, with the highest reductions in restaurants with higher SSB sales per customer (18.77%), the results indicated.
It could be that customers switched to water or other kinds of beverages, potentially fruit juices, or the adults might even choose alcoholic drinks, Cummins said. “We don’t exactly know what they’re substituting for; my guess is primarily water.”A longer follow-up period is required to assess whether the effects will be sustained, the researchers noted. “It’s a straightforward intervention, actually, and there’s no reason why other commercial restaurant chains cannot implement this kind of intervention,” Cummins said. “It wouldn’t require major changes or costs.”
That said, his experience of working with Jamie’s Italian suggested no harm regarding negative financial consequences. “There may be some financial impact, and we don’t know what it might be, but it’s likely not large,” Cummins said. “It may be that other types of chains that sell different types of food might have a larger impact economically” — but this is “fairly unlikely.”

Small changes

“A lot is going on here in this study,” said Jayson L. Lusk, a professor and head of the Department of Agricultural Economics at Purdue University, who did not participate in the research or the analysis. “It’s hard to conclude that the price change in sugar-sweetened beverages is the main cause of the changes being observed,” Lusk said, noting that bottled water and diet cola consumption fell at about the same rate as the increased-price sugary beverages after the intervention began. Meanwhile, the beverages introduced after the price increase introduce a “confound” into the experiment: an element that disrupts and adds confusion to the results. Overall, previous research on this topic suggests that such taxes will probably have small effects on consumption of taxed beverages and that people will merely substitute other high-calorie, non-taxed drinks and foods, Lusk said.
So, can sugar-sweetened beverage taxes lower SSB consumption? “Yes, by a small amount,” he said. “But that’s different than saying sugar-sweetened beverage taxes reduce caloric intake. “There’s also literature showing these taxes tend to be regressive, affecting lower-income households more than higher-income households,” Lusk said. Jason M. Fletcher, a professor of public affairs and sociology at the University of Wisconsin-Madison, said some of the results from the new study suggest a “general weakness in the analysis.” Fletcher did not participate in the new study.
After the intervention, there was a reduction in sales of all types of beverages compared with before the intervention, Fletcher noted, and the authors did not adequately estimate the effects of the 10-pence levy for each beverage in their analysis. “In our own work, we find support for substitution effects in the U.S., where higher taxes on soda lead to two effects: (1) less consumption of soda and (2) more consumption of other high-calorie drinks,” Fletcher said. “Combining these effects can lead to no increase in health.” Americans consume more than 40 gallons of sugary drinks per capita each year, on average.
“Sugar taxes in England have not been proposed, but there is in legislation to be implemented next year as a proposal from Her Majesty’s Treasury on implementing a sugar tax of 20% on producers and manufacturers of sugar-sweetened beverages — so not to the consumer but to the producers themselves,” Cummins said. Some of the major manufacturers have announced that they are going to reformulate their products to avoid the tax. “So in one sense, the policy has already had an effect regarding persuading companies to reformulate their products to avoid the extra costs that will be levied upon them,” Cummins said. “Within the whole of the food system, there are a variety of different types of responses,” he said, adding that he hopes to study these responses. “We’re interested in capturing these kinds of systemwide effects.”
Nutrition Nugget
Eat Your Chocolate! Yes, you read that right! Having a small amount of dark chocolate – 70-85% cocoa – is rich in fiber, iron, and magnesium, among other minerals. Plus, it’s a great source of antioxidants which reduces free radicals in your body.
Word of the Nugget
 Analects: A collection of short literary or philosophical extracts.
Inspiration Nugget
People have to pretend you're a bad person so they don't feel guilty about the things they did to you.

Fatty Liver Linked to Heart Disease


Fatty liver disease is linked to heart failure, according to an article published online in Radiology. Researchers assessed data on liver, heart function, and BMI from 714 participants from the Netherlands Epidemiology of Obesity study. An increase in fat in the liver resulted in decreased coronary blood flow in obese participants despite any pre-existing symptoms of metabolic syndrome. These findings suggest that nonalcoholic fatty liver disease may pose a greater risk for heart failure above and beyond the risk factors already associated with metabolic syndrome and stresses the importance of dietary interventions as a means for prevention.

Widya RL, de Mutsert R, den Heijer M. Association between hepatic triglyceride content and left ventricular diastolic function in a population-based cohort: the Netherlands Epidemiology of Obesity Study. Radiology. Published online January 26, 2016.

Tip of the Day

Celebrate success! Reward yourself when you make small changes to become healthier. Every success, big or small, is a win! Find creative ways to celebrate and make the reward meaningful to you. Celebrate with a new workout video or by relaxing with a cup of tea and a book!

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Baldness Linked to Colorectal Cancer


Male balding patterns are linked to colorectal cancer, according to a study published in the British Journal of Cancer. Researchers assessed hair patterns and cancer incidence rates in 32,782 middle-aged men as part of the Health Professionals Follow-Up Study. Those who experienced frontal-only baldness and frontal-plus-mild-vertex baldness had a 30 percent higher risk for colorectal cancer than those with no baldness, frontal-plus-moderate-vertex baldness, or frontal-plus-severe-vertex baldness. A separate analysis linked frontal-only baldness with increased risk for colorectal tumors. While previous studies linked male pattern baldness to prostate cancer, this is the first to explore similar links with colorectal cancer. Researchers suspect insulin-like growth factor 1 (IGF-1), which is elevated by consumption of dairy products, and excess insulin activity to be possible mechanisms.

Keum N, Cao Y, Lee DH, et al. Male pattern baldness and risk of colorectal neoplasia. Br J Cancer. 2016;114:110-117.

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Support the bones that support you! Keep your body strong by moving to low-fat or fat-free milk or yogurt.

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Food Insecurity and High Healthcare Costs Go Hand in Hand

People with severe food insecurity, who struggle the most to put food on the table, have healthcare costs more than twice as high as people who are food secure, according to a new Canadian study. People who have food insecurity, meaning inadequate or insecure access to food due to low income, “have poorer (physical and mental) health, this is documented extensively for adults and children,” said lead author Valerie Tarasuk of the University of Toronto. “We finally have been able to quantify the healthcare expenditures associated with it,” Tarasuk told Reuters Health by phone. In countries like the U.S., low income might be tied to both food insecurity and poorer access to the healthcare system, which would complicate the analysis, she said. But in Canada, low income people have equal access to the publicly funded health system.

The new study included 67,033 adults in Ontario ages 18 to 64 who had participated in the Canadian Community Health Survey in 2005, 2008 or 2010. The participants answered 18 questions about their daily access to food. The researchers linked their answers, and neighborhood level income data, to a database of participants’ direct healthcare costs in Canada’s publicly funded health care system, including emergency room visits, acute and psychiatric hospital stays, physician visits, day surgeries, home care and prescription drugs. In total, almost four percent of households were marginally food insecure, another five percent were moderately insecure, and three percent were severely insecure. As food insecurity worsened, healthcare utilization and total healthcare costs increased, Tarasuk and colleagues reported in Canadian Medical Association Journal (CMAJ).

During the year before each survey, researchers estimated, food secure individuals cost the healthcare system an average of $1,608, compared to $2,806 for moderately food insecure and almost $4,000 for severely food insecure individuals. All costs were calculated in 2012 Canadian dollars. “What we know is that somebody who is living in a food insecure environment faces many daily struggles, putting food on the table is one of many,” Tarasuk said. Less food, or lower quality food, may influence health status and lead to more medical needs, but there may be other factors involved as well, she said. “If you’re struggling to put food on the table you’re also struggling to pay rent or find work,” she said.

Food insecure people with diabetes will struggle to manage their disease, and this may be true for people with other chronic conditions as well, Tarasuk said. “It is likely that food insecure individuals are not able to manage their health through optimal nutrition due to the cost of food and factors such as living in neighborhoods that lack grocery stores that sell fresh food,” said Noreen Willows, associate professor of community nutrition at the University of Alberta in Edmonton, who was not part of the new Canadian study. Food insecurity is “certainly more common” in the U.S. than in Canada, said Graham Riches of the School of Social Work at the University of British Columbia in Vancouver. Riches was not part of the new study. In 2011, one in six Americans lived in a food insecure household, compared to one in eight in Canada, he told Reuters Health by email.

“We have governments across this country struggling to manage their budgets,” Tarasuk said. “Healthcare is a major expense,” which should give Canadian and international governments an economic incentive to fund programs alleviating food insecurity, she said. “To get healthcare expenses down we need to get food insecurity down,” she said. Low income people should not be discouraged from using the healthcare system, nor should they be asked to rearrange their limited budgets as they are likely knowledgeable about the importance of good nutrition, Willows told Reuters Health by email. “Health care providers such as physicians or registered dietitians could play a role by screening patients for food insecurity and then assisting them to access social workers, publicly funded food assistance programs (where available) or charitable food programs, such as food banks,” she said.

Tip of the Day

What’s the dairy group include? The Dairy Group includes milk, yogurt, cheese, and fortified soymilk. They provide calcium, vitamin D, potassium, protein, and other nutrients needed for good health throughout life.

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