Role of Sugar-Sweetened Beverages in Increasing Non communicable Diseases in Pakistan.

As it is known, consumption of sugar sweetened beverages increasing rapidly which is associated with
various adverse health conditions such as obesity, type 2 diabetes and cardiovascular diseases.
Pakistan has a high burden of these non-communicable diseases. At the same time the sugar-sweetened
beverage industry is rapidly growing in Pakistan.
We should take some preventive measures, awareness campaigns and interventions like taxation to reduce
the disease burden in Pakistan due to these sugar sweetened beverages

Sugar-Sweetened beverages (Sugary Drinks)
What are sugar-sweetend
beverages?

Sugar-sweetened
beverages(SSBS) also known as
sugary drinks are any liquids
that are sweetened with added
sugars(brown sugar, cane juice,
corn syrup, dextrose, fructose,
fruit nectars, glucose etc)
Beverages such as regular soda
(not sugar-free), fruit drinks,
sports drinks, energy drinks,
sweetened waters, and coffee
and tea beverages with added
sugars are sugary drinks.
(Source:CDC)
Role of Sugar-Sweetened Beverages in Increasing Non communicable Diseases in Pakistan.
As it is known, consumption of sugar sweetened beverages increasing rapidly which is associated with
various adverse health conditions such as obesity, type 2 diabetes and cardiovascular diseases.
Pakistan has a high burden of these non-communicable diseases. At the same time the sugar-sweetened
beverage industry is rapidly growing in Pakistan.

We should take some preventive measures, awareness campaigns and interventions like taxation to reduce
the disease burden in Pakistan due to these sugar sweetened beverages.
Non-Communicable diseases (NCDs) in Pakistan:
➢ Noncommunicable diseases (NCDs), also known as chronic diseases, are not passed from person to
person. They are of long duration, generally slow progression and and are the result of a combination
of genetic, physiological, environmental and behavioural factors.
➢ The main types of NCD are cardiovascular diseases (such as heart attacks and stroke), cancers,
chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.
➢ NCDs are taking the lives of Pakistanis everyday.
➢ Pakistan has the 4th highest burden of diabetes worldwide 19.4 million cases. (IDF 2019)
➢ NCDs caused over 800,000 deaths in Pakistan in 2016; 68000 were attributed to diabetes and high
blood glucose (WHO 2016)
➢ NCDs Proportional Mortality In Pakistan:
(WHO:2016)

How do SSBs contribute to overweight obesity and NCDs?
• SSBs can lead to unhealthy weight gain and
non communicable diseases that can cause
premature death.
• The “Empty calories” consumed in SSBs
can lead to weight gain.
• Drinking just one soda a day increases the
likelihood of being overweight by 27% for
adults and 55% for children.
• Liquid sugar in SSBs are harmful to the
body. These Sugars are absorbed more
quickly by the liver (compared to solid
sugars) and alter the body’s metabolism
affecting insulin, cholesterol and metabolites
that cause high blood pressure and
inflammation.
• This high BP and inflammation can increase
risk of diabetes, cardiovascular disease,
tooth decay and liver disease.
Consumption of sugary drinks in Pakistan-2018:
• Carbonated drinks 4426 million litres with value of PKRs 387 billion.
• Energy drinks 224 million litres with value of PKRs 58.7 billion.
• Juices 733 million litres and value of PKRs 79 billion
• Carbonated drinks are forecasted to grow at a Compounded Annual Growth Rate (CAGR) of 7.3%
• Juice industry is growing with 20% value and 7% volume.
• With current trends and CAGR the juice industry will become 199 billion value with 1 billion litres of
sale in 2023.

Taxing Sugar Sweetend beverages:
Why tax sugar-sweetened beverages?
Taxes have been shown to decrease consumption of SSBs.

• A tax on SSBs is an important first step in fighting obesity and obesity related diseases.
• Leading health organisations like the WHO have published guidelines saying individuals should
consume no more than 10% of total calories from added sugar.
• A Single 330 ml can of soda contains more than 9-11 tsp of added sugar the almost equivalent of the
maximum recommended daily intake by WHO.
• SSB taxes reach large numbers of people at relatively low cost. The tax is paid by everyone who buys
a sugary drink with Virtually no cost to the government- in fact it produces revenue.
• Universal healthy food policies are more cost-effective and can reach more people than individual
one-on-one strategies.

SSB taxes work: latest Global evidence
SSB tax in Mexico: a longitudinal study:
• Key takeaway: Consumption among the population surveyed reduced in the three years following
the tax implementation.
• 56% to 43% classified as medium high SSB consumer
Chile: A time series analysis (Cuadrado 2020):
• Soda (carbonates) prices increased by 5.6 %(no effect on juices)
• Effect 3 months after implementation.
• High pass-through rate than expected.
What do evaluation findings to date suggest?
• Evidence from Mexico, Chile, Portugal, Saudi Arabia Barbados, several U.S. cities and the
catalonia region of Spain Industry can cost-shift or even decide to eat part of the tax
• Consider package size; beverage types; location (urban/rural, type of stores income level of
neighbourhood) ;manufacturer vs. retailer behavior
• Taxes can help dampen demand for SSBs and shift demand to Healthier alternatives (like bottled
water)
• No net change in employment due to substitutions and offsetting effects.
Impact of taxes on Reduction of obesity:
Sr
no
Country Study
method
Impact
1. India 2014 Modeling 20% tax leads to 3% reduction in obesity and overweight and
1.6% reduction in type 2 Diabetes. The largest fact was found in
rural young men.
2. South Africa 2014 Modeling 20% tax leads to 3.8% reduction in obesity prevalence in men
and 2.4 % reduction in women
3. Australia 2016 Modeling 20% tax leads to 2.7% reduction in obesity prevalence in men
and 1.2 % reduction in women.Increase in tax revenue of 400
million dollars Annually
4. United Kingdom 2013 Modeling 20% tax reduced consumption of concentrated SSB 15% and non
concentrated 16% reduce 2.2 % of obesity + overweight in adults.
increase in tax revenue of 276 million annually.
5. Ireland 2013 Modeling 10% tax leads to 1.3% reduction in obesity and 0.7% reduction in
overweight.
Policy Recommendations SSB Pakistan:
• Impose health levy – healthy levy bill.
• Increase FED and make it less affordable to buy sugary drinks.
• Consider both healthy levy and increase in FED. Allocated generated revenue to health and nutrition
programs.
The global evidence suggests that a decrease in the consumption of sugary drinks can reduce overweight
and obesity. There are number of strategies which could be adopted to reduce the consumption of sugary
drinks. These strategies includes removal of these drinks from public places like schools, adding FOPL
warning signs, restricting marketing and increasing tax to raise the price, hence making it less affordable
for consumers.
References:
• Ahmad, Iftikhar. “Non-communicable diseases: a rising problem.” Gomal Journal of Medical
Sciences 18.1 (2020)
• Wanjohi, Milkah N., et al. “Nutrition-related non-communicable disease and sugar-sweetened
beverage policies: a landscape analysis in Kenya.” Global Health Action 14.1 (2021)
• Nisar, Nighat. “Childhood obesity: A major public health challenge of 21st century.” Journal of the
College of Physicians and Surgeons Pakistan 28.11 (2018)
• Allcott, Hunt, Benjamin B. Lockwood, and Dmitry Taubinsky. 2019. “Should We Tax SugarSweetened Beverages? An Overview of Theory and Evidence.” Journal of Economic Perspectives.
• Bleich SN, Wang YC, Wang Y, Gortmaker SL. Increasing consumption of sugar-sweetened
beverages among US adults: 1988-1994 to 1999-2004. Am J Clin Nutr. 2009.
• Escobar, Maria A. Cabrera, et al. “Evidence that a tax on sugar sweetened beverages reduces the
obesity rate: a meta-analysis.” BMC public health 13.1 (2013).
About the Author:
This Blog is written by Wania Shahid
a student of Bs Human Nutrition and Dietetics(HNAD) 6th semester
under the Supervision of Dn. Shoaib Aziz(Lecturer at KFUEIT).