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Tabinda Ashraf Shahid has done her M.Phil & MS in (Food and Nutrition). Professionally she is a registered Dietitian/Nutritionist. She has served as a Dietitian in Shifa International Hospital Islamabad.

Tabinda Ashraf Shahid
Registered Dietitian/Nutritionist
E.mail address: tabinda08@gmail.com
PNDS Number: L-0072-12

 

 

 

 

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Tabinda Ashraf Shahid has done MSc and MPhil in Food and Nutrition. After doing her Masters she joined Shifa International Hospital and served both as a Dietitian in FNSD and also as a Clinical Nutritionist under the supervision of Dr. Rezzan Khan. At Shifa, she remained engaged in a multitude of activities arranged for the betterment and awareness of patients and the general public. She also actively participated in making information flyers for particular diseases.

She also worked as a freelance Public Health and Nutrition writer since 2012. She has published different articles in Daily Dawn. In 2012 she became a Registered Dietitian/ Nutritionist of Pakistan Nutrition and Dietetic Society (PNDS) and started online practice.

She actively participated in Continuing Nutrition Education by PNDS. During Covid-19, and participated in various online International Conferences and webinars organized by ECHO, Nestle, Abbott Nutrition-ANHI, Nutri web UK, GAIN Switzerland, and many others.

Currently, she is serving as an Assistant Editor in Scientific Investigation and Global Network of Scientists (SIGNS) which is a quarterly newsletter on health and nutrition.

In January 2020 she founded ‘Therapeutic Nutrition’, a platform for online consultation for clients and patients and a page on Facebook with her colleague to promote awareness about health and wellbeing by highlighting the importance of diet and nutrition. Evaluation of nutritional assessment and guidance accordingly is provided to national and international clients. Her team also educates other health professionals on Dietetics through infographics depending on the latest successful trends and researches in nutrition.

The Role of Sweetened Beverages in Increasing Non-Communicable Diseases in Pakistan

Tabinda Ashraf Shahid

Ali’s mother is conscious about his school lunch, she prepares homemade sandwiches with a commercially packed fruit juice drink which is perceived by many people as a healthy option. She does not want her young to eat or drink unhygienic and unhealthy food from the canteen. Although the lunch is scrumptiously homemade she is unaware of the fact that the fruit juice is accompanied by high sugar contents. Additionally, to avoid drinking water from his school Ali often takes a soft drink while waiting for his van way back home. These sugary sweetened juice and drink are hiding excess sugar and drinking it five days a week means a lot of calories are consumed. Due to repetitive promotions, people don’t categorize it as unhealthy. On the contrary, highly sweetened beverages once per day have been proved to rise BMI[1]and accelerate 20% risk of cardiovascular disease[2]

KNOWING SUGAR SWEETENED BEVERAGES(SSBs)

The term SSBs signifies any beverage synthetically prepared with sugar in any form of table sugar, high fructose corn syrup, or concentrates of fruit juice. These enriched calories with low nutritional value beverages are available at every nook and corner of rural and urban areas of Pakistan and contribute to obesity as a constellation of Non-Communicable Diseases (NCDs). The consumption of SSBs has flourished due to the influence of rapid urbanization and marketing strategies[3]

Non-Communicable Diseases[4]are associated with one of 10 major causes of disease and death in Pakistan. Internationally, SSB’s are accountable for about184,000[5] deaths annually from obesity, diabetes, and cardiovascular disease.  However, the overconsumption of SSBs is associated with the addiction of caffeine and sugar in the young generation, bringing them closer to the detrimental diseases. The emerging cause of NCDs has subsequently elevated a threat to the health community due to weight gain and obesity in Pakistan [6].

Internationally SSBs are accountable for about 184,000 deaths annually from obesity, diabetes, and cardiovascular disease

FACTS AND FIGURES

The Covid-19 pandemic has not yet been over, and another pandemic is Obesity [7][8]is a heading that is often ignored because its effect may take time to show. The World incidence of overweight and obesity is on the rise among children, women, and men which is responsible for Type 2 Diabetes (T2D) and other cardio metabolic diseases [9].

The Director of WHO NCD 2016 Dr. Douglas Bettcher indicated the need for taxation on all SSBs as one of the main sources of obesity and diabetes accountable for millions of death. Globally, the rate of obesity fluctuated drastically in 2014 as compared to 1980 with an increase in the percentage of women than men. While 42 Million children under 5 years were categorized as obese in 2015, more than half of the children were from Asia and a quarter from Africa[10].

According to the statistics of WHO 2021, NCDs are responsible for more than 70% of deaths annually worldwide within the age bracket 30 to 69. While in low middle-income countries 77% of deaths are associated with NCDs including the highest cases of cardiovascular diseases than followed by cancers, respiratory diseases, and diabetes[11]. The role of SSBs can be clearly understood by a study published in 2019 on the Spanish population on the use of SSBs which suggested an increase in BMI of 0.21kg/m2 on every 100ml of SSB consumed. It has compelled the Government of Catalonia to impose Excise Tax on SSBs [12].

Obesity is not only associated with affluent societies but an estimated 115 million people from low-income countries[13] also suffer from this dreaded condition and its consequences. The significant factor is recognized as the consumption of soft drinks[14] thus WHO has documented obesity as a global pandemic[15]

Pakistan is the place where malnutrition is only considered as under nutrition typically, while people with overweight are praised to be in a good health. In such a society advocating for weight loss sometimes seems unimportant. But according to a recent study one out of four Pakistani above 18 are categorized as overweight, while women[16]are more prone to overweight and obesity as compared to men. A systematic analysis of Global Burden of Disease 2013 stated that Pakistan is at 8thnumber among 10 countries contributing to obesity in the world [17].

It is of major concern that the findings of the national NCD survey 2013-14 in two provinces of Pakistan suggested unhealthy diet consumption in the obese and overweight population and they are at increased risk of NCD later in their life[18].

The National Diabetic Survey 2016-2017 has revealed 35 to 38 million(16)young people aged 20 years and above are suffering from TD2 in Pakistan.

The consumption of SSBs is becoming an indispensable commodity that is directly proportional to the richer families. The validated research data from Pakistan shows that in 2015-16 the poor families have spent more on SSBs than between 2006-08. This overconsumption of sugar is causing an extra disease burden on the Pakistani population in the form of cardiovascular risk, type 2 diabetes, and hypertension[18].

HOW DIFFERENT COUNTRIES ARE TAKING THE LOAD OF SSB

As the cost of soda and colas are nominal and in the reach of the general public its use has been increased, hence, in 2017 WHO suggested a 20% tax on SSB as an effective tactic to overcome SSB usage[19].

About 50 countries including the USA imposed different types of taxes on SSBs products including Excise tax and Value-added taxes. The UK has also introduced a two-tier tax in 2014 depending on the amount of sugar content used in preparation. SSBs having more sugar contents than 8g/100ml and 5gm/100mlare taxed, accordingly. In 2014 Mexico started tax rates subject to the volume of sugar-sweetened drinks while the Pacific Island countries also imposed SSB taxes[20].

It has been seen that additional taxes contributed to generating more revenue once imposed. While generated money can be utilized for the betterment of the healthy community and awareness campaign for NCDs.

According to research in Zambia[21]when low-middle-income countries increased taxation on SSBs it showed a decreasing trend in BMI and obesity-related diseases, especially in women. A prospective effect of SSBs in Ireland, Germany, South Africa, the Philippines and India exhibited a successful reduction in SSBs practices[22].

According to the Tribune[23], the preference and demand for soft drinks have increased after Covid-19 and people like to buy family packs which is more economical instead of bottles with one serving which shows that the money is the main reason which compels people to buy the product. Due to the westernized trend, local home drinks like lemonade and lassi which have more nutritive value are not preferred by many.

Observational studies[24]endorsed taxation policies on SSBs and specify that they can reduce excess weight by about 200 million pounds around the world. It will not only affect the household budget situations but it will save money to be used on other health care projects while increasing the life expectancy and will increase the workforce for the community to boost the economy.

It has been noted that 25% sin tax in Zambia[25]on alcohol, tobacco, and SSBs has abridged the intake of calories, has reduced weight, BMI and subsequently NCD diseases burden.

Many countries adopted health encouraging policies like Latin America by the introduction of warning signs on labels of SSBs about the sugar contents of the drink to get customers aware of their negative impact on health proved to be a practical solution[26].

POLICY SOLUTIONS FOR PAKISTAN

  • On the advice of WHO SSB’s tax implementation by 25% as in Zambia has restricted the buying ability of consumers which has contributed to the reduction of weight, BMI, and NCD burden. Health authorities from Pakistan can also take similar action to eradicate NCDs to some extent.
  • Initiation of federal NCD policy to control the surge of these diseases.
  • Pakistan National Heart Association (PANAH) has suggested FBR impose a 20% Tax on all Sugar-Sweetened Drinks⦁ [27]⦁ .
  • Cheap and readily available SSBs are a source of increased consumption of unhealthy diet which should be increased under Taxation.
  • Reduced Sugar Beverages⦁ [28] should be introduced with enhanced warning labeling.
  • There is a need for awareness campaigns about the consumption of healthy options like the inclusion of fruits and vegetables in the diet and the importance of exercise to motivate people to become active individuals.
  • Excise tax and value-added tax should be constantly reviewed for SSB products.
  • A two-tier tax must be imposed depending on the amount of sugar used in the preparation of each SSBs. While the volume of the drink should also be considered and should be taxed accordingly.

  • Tax generation will aid in increasing the revenues⦁ [29] which can be used for nutritional or educational interventions as many studies have revealed.
  • Schools should be free from sugar-sweetened beverages for more healthy options.
  • In schools at every parent-teacher meeting, a dietitian/ Nutritionist should be available to give 15 minutes lecture on the healthy school lunch program. The nutritional assessment of all children in school should be arranged under a dietitian/nutritionist annually.
  • Taxation on SSBs will impact by reducing the NCD cases in any society which will save money spent on hospital care and will increase the work output hours.
  • It has been noted that increased taxes⦁ [29]helps in the prevention of addiction to SSBs which can control weight and cardio metabolic disorders related to diet.
  • It will impact the purchasing power of the consumer and they will buy other healthy food instead. It has been observed that a 10% increase⦁ [30] in tax will reduce a 10% drop in usage.
  • Some easy-to-read and follow info-graphics should be present on the SSBs labels to aware the customers whether they drink they are buying is healthy or not.
  • Use of water should be emphasized for hydration where ever possible as an alternative of SSBs⦁ [31]⦁ .

References:

  • https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7908-5
  • https://www.ahajournals.org/doi/10.1161/CIRCULATIONAHA.111.067017
  • https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/sugary-drinks/
  • http://www.emro.who.int/emhj-volume-24-2018/volume-24-issue-1/prevalence-of-risk-factors-for- noncommunicable-diseases-in-adults-key-findings-from-the-pakistan-steps-survey.html
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377978/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6488513
  • https://pubmed.ncbi.nlm.nih.gov/15601956/
  • https://pubmed.ncbi.nlm.nih.gov/15601956/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828681/
  • https://www.who.int/news/item/11-10-2016-who-urges-global-action-to-curtail-consumption-and-health-impacts-of-sugary-drinks
  • https://www.who.int/news-room/fact-sheets/detail/noncommunicable-diseases
  • https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7908-5
  • https://www.who.int/activities/controlling-the-global-obesity-epidemic
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3828681/
  • https://pubmed.ncbi.nlm.nih.gov/16326822/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7118000/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4624264/
  • https://pubmed.ncbi.nlm.nih.gov/29658619/
  • https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0105287
  • https://www.obesityevidencehub.org.au/collections/prevention/countries-that-have-implemented-taxes-on-sugar-sweetened-beverages-ssbs
  • https://gh.bmj.com/content/5/4/e001968#ref-
  • https://www.who.int/news/item/11-10-2016-who-urges-global-action-to-curtail-consumption-and-health-impacts-of-sugary-drinks
  • https://tribune.com.pk/story/2277439/beverages-sector-recovers-as-preferences-shift)
  • https://openknowledge.worldbank.org/handle/10986/33970?locale-attribute=en
  • https://gh.bmj.com/content/5/4/e001968
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6520104/
  • https://tribune.com.pk/story/2305772/pakistan-a-diabetes-disaster-in-the-making
  • https://www.hsph.harvard.edu/nutritionsource/healthy-drinks/beverages-public-health-concerns/#ref62
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7377978/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5442881/
  • https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723421/
  • https://unsplash.com/ (all pictures)
  • Graphic Illustration by Alia Ambreen
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