Proposed tax on sugar-sweetened beverages could generate revenue, reduce obesity rates
A group of medical researchers are proposing a 1-cent
per ounce tax on beverages that contain any added caloric sweetener as an
attempt to alleviate escalating health care costs and the rising number of
diseases related to poor diet.
In a health policy report published in The New
England Journal of Medicine, researchers at Yale, Harvard School of
Public Health and other U.S. institutions explained that the link between
sugar-sweetened beverages and obesity, as well as type 2 diabetes and
cardiovascular disease, has been demonstrated in several studies, including the
Nurses’ Health Study.
The researchers claim the 1-cent per ounce tax would
increase the cost of a 20-oz soft drink by 15% to 20%. Price elasticity
suggests a decrease in consum-ption of 8% to 10%, with an even greater decrease
in consumption expected after consumers begin switching to diet beverages. The
researchers estimated that consumers would substitute calories in other forms
for 25% of the reduced calorie consumption, leading to a minimum reduction of
10% in calorie consumption or 20 kcal per day from sweetened beverages, which
they said is sufficient for weight loss and risk reduction.
The 1-cent per ounce tax would generate $14.9 billion in
the first year, according to the researchers. The money generated could be used
to support childhood nutrition programs, obesity prevention programs, health
care for the uninsured or to help meet general revenue needs. At the state
level, the researchers wrote that revenue would range from $139 million in
Arkansas to $1.8 billion in California.
An alternative to the 1-cent per ounce tax would be to
tax beverages that exceed a threshold of grams of added caloric sweetener. The
researchers suggested this threshold be set at 1 g of sugar per ounce. The
specific excise tax — a tax levied on units such as volume or weight
— could be levied on the producers and wholesalers, according to the
researchers. The cost would then be passed along to retailers, which would
incorporate it into the retail price, therefore making consumers aware of the
cost at the time of purchase.
Although the researchers emphasized the need for an
excise tax, rather than a sales tax, they did suggest states that currently
exempt sugar-sweetened beverages from sales taxes eliminate this practice.
However, consumer groups have expressed disagreement
with such a tax.
“Taxes on soda are a distraction that won’t
address the real problem facing overweight Americans — an epidemic of
inactivity,” J. Justin Wilson, senior research analyst at the Center for
Consumer Freedom, said in a press release. “The American people
overwhelmingly oppose it and science shows that it will have little to no
impact on our weight.”
Last month, the Center for Consumer Freedom called on
President Barack Obama to abandon ideas of a new tax on soft drinks after he
was quoted saying he is open to “sin taxes” on soda in hopes of
curbing obesity. The nonprofit group cited data that indicate these taxes do
nothing to address the problem of obesity, and instead show that physical
inactivity is the single largest contributor to obesity among children.
Further, results of a recent Opinion Research
Corporation poll of 1,006 Americans reveal that 65% of those polled disagree
that soft drinks should carry extra taxes to discourage their consumption.
– by Tina DiMarcantonio and Katie Kalvaitis
Brownell KD. N Engl J Med.
2009;doi:10.1056/NEJMhpr0905723.
I got some flak
for a blog I wrote recently in which I indicated that in some patients,
probably most, obesity is an eating disorder just as are anorexia and bulimia.
As such, obesity should be treated/managed and not punished.
The NEJM article makes a compelling case
for the contribution of sugar-sweetened beverages to obesity and that
consumption would decrease if they were priced out of the market by adding a
special tax. It is also true that the tax revenue could be put to good use by
spending it on the management of obesity. But that’s not an approach to
obesity that I would favor, and why just tax sweetened beverages?
Ideally, obesity should be prevented, but I’m not
certain that we have enough understanding of the underlying biology to develop
a universally effective program; we know enough to make a good start. Placing
nutritional information on packaged foods and beverages has not had any
appreciable effect on the prevalence of obesity because it was never linked to
any meaningful public education.
What is needed is a well-developed education program
starting in grade school, and such programs already exist. The
Power of
Prevention initiated by Donald Bergman, MD, from Mt. Sinai School of
Medicine should be brought to the attention of the Secretary of Health and
Human Services and the Secretary of Education, and the program, or something
similar, should be incorporated into the grade school curriculum ASAP.
– Michael Kleerekoper, MD, MACE
Director, Endocrinology Fellowship Program, Rechert Health
Center, Saint Joseph Mercy Hospital
Undoubtedly, the epidemic of obesity that we are
experiencing in the United States, and the world for that matter, is having a
major impact on the health of the nation. The high sucrose in the diet of
Americans compared to, say, Europeans is one of many factors involved in the
increase in obesity. One way to reduce this effect is to reduce the intake of
sweetened sodas. It is very unlikely that education alone will impact on the
use of sodas, and drastic measures are sometimes necessary. We all recall the
important effects of implementing laws regarding seat belt use or taxes on
tobacco. A tax on sodas is being considered as a means of reducing their
intake. It is a regressive tax, in that it will cost the lower income groups
relatively more than upper-middle class individuals, but if the proceeds are
guaranteed to go toward health care needs, it would be a win-win situation; if
it went to state spending on other programs, then I would not be that
supportive.
– Derek LeRoith, MD, PhD
Chief, Division of Endocrinology, Diabetes & Bone
Diseases, Mt. Sinai School of Medicine
A proven way to decrease the utilization of alcohol and
tobacco products is to apply a ‘sin tax.’ This should also be
effective with sugar-sweetened beverages if the taxation is severe enough to
qualify for ‘aversion therapy.’
– David S. H. Bell, MD
Professor of Medicine, University of Alabama School of
Medicine
This is a very naive paper based more on fiction than
fact. It makes one wonder who peer reviewed it. Was it Big Brother?
Let’s consider the medical realities. Without the
use of medications, terminal cancer or amputation, a review of the literature
shows that less than 5% of people are able to lose 20 lb or more and keep it
off.
Oprah Winfrey could be considered the poster child for
this statement. She has lost the same 50 lb multiple times, only to gain it
back again. If there is any question as to whether there is ‘money in
fat,’ note the plethora of weight loss programs available in our country
today. Unfortunately, most are only successful in the ‘medical
debridement’ of the patient’s wallet.
In a rich prosperous society, food is readily available
and so are many labor-saving devices. One result of this is obesity. But
consider the alternative: In poor societies, obesity problems don’t exist
because the people must work very hard for every morsel of food they are able
to scrape from their meager existence. It is in the poorest societies that we
see the greatest weight loss occurring.
In light of this, perhaps the authors are right in
recommending that the tax code be used to decrease the consumption of sugared
soft drinks. But they don’t go far enough with their meager excise tax of
1-cent per ounce on beverages. To be successful, they will need to tax
substantially not only these drinks but also Twinkies, Bon-Bons, meats, fruits,
vegetables and all of the other foods and products that we buy.
To correct the problem of excess caloric intake, they
will need to get to the root of the problem — which is wealth. By removing
their wealth, people will not have the money to buy excessive amounts of food.
In light of this, the authors should take pleasure in the current deficit
spending of trillions of dollars by our government. When the bill comes due,
our taxes will skyrocket and our society will become poorer, but at least we
will all be ‘healthier.’
– Richard Dolinar, MD
Senior Fellow in Healthcare Policy, Heartland Institute
