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Global SSB and Sugar Consumption Patterns, Policies, Taxes, and Other Issues

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Global SSB and Sugar Consumption Patterns, Policies, Taxes, and Other Issues Global SSB and Sugar Consumption Patterns, Policies, Taxes, and Other Issues Barry Popkin Department of Nutrition School of Public Health and Medicine Department of Economics The University of North Carolina at Chapel Hill THE W RLD IS FAT “Over 2 billion people in the world are overweight” Outline: Why is This Occurring? 1. In-depth look first: added sugar in modern food supply, 2. Key ignored issue: the maldistribution of intake of added sugar 3. Global SSB consumption patterns 4. Fruit Juices: are they any different than SSB’s in their health effects? 5. Policies being utilized: taxes, labeling, marketing controls, restrictions in selected environments • Mexico • Berkeley • Chile “Over 2 billion people in the world are overweight” Remarkably Short History for Caloric Beverages: Might the Absence of Compensation Relate to This Historical Evolution? Earliest possible date US Soda Intake 52/gal/capita Definite date (2004) US Coffee Intake 46 gal/capita (1946) Juice Concentrates (1945) US Milk Intake 45 gal/capita present (1945) - 10,000 BCE 10,000 - Coca Cola (1886) Homo SapiensHomo - Pasteurization (1860-64) Origin of Humans Origin Pre 10,000 BCE BCE 10,000 Modern Beverage Era ModernBeverage Carbonation (1760-70) 200,000BCE Liquor (1700-1800) Lemonade (1500-1600) Coffee (1300-1500) Brandy Distilled (1000-1500) (206 AD) Tea (500 BCE) Wine, Beer, Juice Wine (5400 BCE) (8000 BCE) Beer (4000 BCE) Milk (9000 BCE) 2000 BCE Water, Breast Milk 200000 BCE Homo Sapiens 100000 BCE 0 of Time Beginning 200000 BCE 200000 10000 BCE 10000 AD BCE 1. Sweeteners in Our Food Supply • About 550,000 foods and beverages exist in our consumer packaged food and beverage system in the US. • About 100,000 have unique ingredients. Using these data from a nationally representative sample of about 60,000 households who daily scan all food purchases’ bar codes, we can identify the foods with sweeteners. • Two sets of data—older published paper on difference from US NHANES data and our data with ingredients searched. • Then new results—in press only “Over 2 billion people in the world are overweight” Sweeteners in Our Food Supply • Key word searches at the ingredient list of each product – Low-calorie sweeteners: artificial sweetener, aspartame, saccharin, sucralose, cyclamate, acesulfame K, stevia, sugar alcohols (i.e. xylitol) and brand name versions of each sweetener (i.e. Splenda) – Caloric sweeteners: fruit juice concentrate (not reconstituted), cane sugar, beet sugar, sucrose, glucose, corn syrup, high fructose corn syrup, agave-based sweeteners, honey, molasses, maple, sorghum/malt/maltose, rice syrup, fructose, lactose, inverted sugars Caloric Sweetener Low-calorie Sweetener Sources of Sweeteners Caloric Low calorie LCS and CS sweetener sweetener All Foods and Beverages that Contain Any Sweetener A. NHANES, 2007-2010 B. HOMESCAN, 2007-2010 LCS CS LCS CS LCS+CS 500 500 stores stores 400 400 15 % from from 73 % 300 300 59 % 7 % 200 200 capita total store purchases store total capita capita total intake intake total capita Per Per Per Per 100 100 92 % 27 % 95 % 26 % 5 % 1 % 0 0 Beverage Food Beverage Food • Means per capita for beverages (mL/d) and foods (g/d). LCS, low-caloric sweetened beverages or foods; CS, caloric-sweetened beverages or foods • Piernas et al, Pediatrics Obesity 8:294-306 The % of Uniquely Formulated Foods and Beverages in the US Food Supply Containing Sweeteners (Mutually Exclusive Categories) 100% 3 2 2 2 4 5 7 9 90% 15 80% Any FJC 70% 63 58 63 60 55 66 66 51 Both NS and NNS 60% 45 by by weight 50% NS only 40% NNS only 5 9 14 12 sweeteners 30% 3 6 No added sweeteners 20% 34 % of unique formulationscontainingunique% of 30 32 31 31 29 28 26 28 10% 0% 2000 (N= 4,666) 2000 (N= 9,371) 2006 2013 (N=16,512) 2013 2000 (N= 40,562) 2000 (N= 76,971) 2006 (N= 35,896) 2000 (N= 67,600) 2006 2013 (N=113,015) 2013 2013 (N= 129,527) 2013 All CPG Foods & Beverages Foods only Beverages only NS= Nutritive/Caloric Sweetener, NNS= Non-nutritive/non-caloric sweetener, FJC= Fruit Juice Concentrate (excluding lemon/lime and when reconstituted) (not for use or quotation) (Popkin and Hawkes, Lancet Diabetes for fall/winter) % of Uniquely formulated CPG Purchases by Weight in Grams Containing Sweeteners (Weighted to Be Nationally Representative) 100% 1 3 1 2 2 1 5 6 10 90% 80% 39 47 34 Any FJC 70% 57 51 48 70 69 65 60% Both NS and NNS 50% NS only 21 17 40% 9 18 NNS only sweeteners 12 10 30% No added sweeteners 20% 39 36 33 35 31 32 29 28 32 % of purchases by weight containingby weight purchases% of 10% 0% 2000 2006 2013 2000 2006 2013 2000 2006 2013 All CPG Foods & Beverages Foods only Beverages only NS= Nutritive/Caloric Sweetener, NNS= Non-nutritive/non-caloric sweetener, FJC= Fruit Juice Concentrate (excluding lemon/lime and when reconstituted) (not for use or quotation) (Popkin and Hawkes, Lancet Diabetes for fall/winter) % of CPG Purchases by Calories Containing Sweeteners Weighted to be Nationally Representative (Excludes Low Calorie Sweeteners by Using Kcal) 100% 0 0 1 2 1 1 1 2 5 90% 80% Any FJC 70% 55 53 47 66 69 69 72 71 68 60% Both NS and NNS 50% NS only 40% NNS only sweeteners 30% No added sweeteners 48 20% 42 44 32 29 29 27 27 30 % of purchases by containingby caloriespurchases% of 10% 0% 2000 2006 2013 2000 2006 2013 2000 2006 2013 All CPG Foods & Beverages Foods only Beverages only NS= Nutritive/Caloric Sweetener, NNS= Non-nutritive/non-caloric sweetener, FJC= Fruit Juice Concentrate (excluding lemon/lime and when reconstituted) (not for use or quotation) (Popkin and Hawkes, Lancet Diabetes for fall/winter) 2. United States: Added Sugar and Beverages: Patterns and Trends • US trends overall • Changes in the distribution “Over 2 billion people in the world are overweight” Hook consumers early, gain a consumer for life: “Babies who drink soda during their early formative period are much more likely to fit in during those awkward preteen and teen years” “Over 2 billion people in the world are overweight” Adjusted Mean Calories of Daily Added Sugars by US Individuals for Foods and Beverages 1977 to 2003 change 2003 to 2012 change 1977 to 2003 change 2003 to 2012 change • Beverages:+3.6kcal/year • Beverages:-5.6 kcal/year • Beverages:+3.5kcal/year • Beverages:-3.9 kcal/year • Foods: +.6kcal/year • Foods: -1.2 kcal/year • Foods: +.9kcal/year • Foods: -.3kcal/year 400 Foods 350 Beverages 300 198 179 142 250 163 168 147 138 144 163 200 163 122 119 150 100 192 208 199 165 157 165 162 164 136 50 112 109 121 0 1977-1978 1989-1991 1994-1998 2003-2004 2009-2010 2011-2012 1977-1978 1989-1991 1994-1998 2003-2004 2009-2010 2011-2012 Children 2-18 Adults 19 and Older Adjusted by Gender, Race, Income and Education, Weighted to Be Nationally Representative Trends in Quintiles of Added Sugar Distribution in the US (Excludes Fruit Juice Concentrate), Kcal/Day. Note the large skewed distribution. A. Children aged 2-18 B. adults 19 and older 794 800 741 722 712 705 708 700 673 613 620 587 600 565 557 500 412 411 400 354 356 355 357 342 336 Kcal/day 302 310 301 306 300 266 266 226 232 224 227 213 208 198 192 198 193 200 158 153 129 118 129 136 117 132 106 108 99 102 100 58 52 53 52 47 41 37 44 29 26 26 20 0 1977-1978 1989-1991 1994-1998 2003-2004 2009-2010 2011-2012 1977-1978 1989-1991 1994-1998 2003-2004 2009-2010 2011-2012 q1 q2 q3 q4 q5 Powell et al, (not for use or quotation) 3. Global Trends— Both in Kcal by Region and Country and Volume • Euromonitor passport data: excellent on trends, levels appear to be under-reported as expected as they do not obtain data from all companies. Pilot study worked with them. they obtain kcal from each country for most beverages. • Kcals based on calories from beverages in each country. They get this off websites and nutrition facts panels. If anything, these are a major undermeasurement as many local companies underreport their kcal, total sugar and other data. “Over 2 billion people in the world are overweight” Daily Calories Sold per Capita per Day from all Sugar-Sweetened Beverages in 2014 by Region (Weighted by Population) North America Latin America Australasia Western Europe Middle East and Africa World Eastern Europe Asia Pacific 0 20 40 60 80 100 120 140 160 kcal/d per capita Source: Euromonitor Passport International with country-specific kcal data added (not for use or quotation) (Popkin and Hawkes, Lancet Diabetes for fall/winter) kcal/d per capita 180 100 120 140 160 20 40 60 80 0 Diabetes for fall/winter) forDiabetes Source: NorthAmerica 2009 2010 Euromonitor 2011 2012 2013 Caloric 2014 Latin America 2009 Passport International with with country International Passport 2010 2011 2012 2013 Trends 2014 2009 Australasia 2010 2011 by 2012 in 2013 Sugar 2014 Region Western Europe 2009 - specific kcal data added specificadded kcaldata 2010 2011 2012 - Sweetened Beverage Sales Beverage Sweetened 2013 2009 , 2014 MiddleEastand 2009 2010 Africa 2011 - 2012 2014 (not for use or quotation) (Popkin and Hawkes, Lancet and (Popkin or quotation) foruse (not 2013 2014 Eastern Europe 2009 2010 2011 2012 2013 2014 Caloric Soft Drinks Caloric Soft Drinks Juice Drinks Energy Sports and 2009 2010 World 2011 2012 2013 2014 2009 Asia Pacific 2010 2011 2012 2013 2014 kcal/d per capita 100 120 140 160 180 200 20 40 60 80 0 Source: 2009 2010 Chile Euromonitor 2011 Calories 2012 2013 2014 United States Passport International with with country International Passport 2009 2010 2011 Sold 2012 2013 Beverage 2014 2009 per Mexico 2010 2011 Capita 2012 2013 2014 by - 2009 specific kcal data added (not for use or quotation) foruse (not specificadded kcaldata 2010 per Brazil Country 2011 2012 2013 Day 2014 United Kingdom 2009 2010 2009 , from 2011 2012 2013 2014 Sugar - 2009 2014 Colombia 2010 2011 2012 - 2013 Sweetened 2014 2009 Caloric Soft Drinks Caloric Drinks Juice Drinks and Energy Sports Thailand 2010 2011 2012 2013 2014 2009 2010 China 2011 2012 2013 2014 Supplemental Figure 1.
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