Equitability of Individual and Population Interventions to Reduce Obesity: A Modeling Study in Mexico.

INTRODUCTION: Modeling studies have estimated the potential impact and cost effectiveness of interventions to reduce obesity; few have focused on their equity across socioeconomic groups. This study aims to compare the equitability of individual- and population-level interventions to reduce obesity in Mexico. METHODS: Mathematical models were implemented to estimate the expected effect of 2 sugar-sweetened beverage tax scenarios (10% and 20%) and bariatric surgery, pharmacotherapy, and dietary advice as individual interventions to reduce body weight. Individual interventions were modeled using meta-analytical weight change, inclusion and exclusion criteria, and the probability of access to healthcare services. For the tax, investigators obtained the baseline consumption of sugar-sweetened beverages from the National Health Survey 2012 and applied the reduction in sales observed in 2016 to estimate the caloric change and weight reduction. Implementation costs and cost per person, per kilogram, and equity were calculated for all interventions over a 1-year timeframe. RESULTS: The 20% tax produced the largest estimated increase (4.50%) in normal BMI prevalence, was the most cost effective, and had the largest and most equitable decrease in obesity across socioeconomic categories. Pharmacotherapy and bariatric surgery produced sizable decreases in obesity prevalence (3.68% and 1.18%), particularly among the middle and high socioeconomic groups, whereas dietary advice had the lowest impact on normal and obese categories. CONCLUSIONS: Individual interventions were effective in reducing obesity; yet, they were more expensive and less equitable than population interventions. Obesity in Mexico affects all socioeconomic groups; available interventions need to be carefully analyzed to tailor a national strategy that is both effective and equitable.

Body weight impact of the sugar-sweetened beverages tax in Mexican children: A modeling study.

BACKGROUND: In Mexico, a 10% tax to sugar-sweetened beverages was implemented in 2014. Projections of the potential health effect of this tax in children are not available. OBJECTIVE: To estimate the 1-year effect of the tax on the body weight of children 5 to 17 years old, and estimated alternative scenarios with higher tax rates (20%, 30%, and 40%). METHODS: We used a dynamical mathematical model, recalibrated to the Mexican population. Input data were obtained from the Mexican National Health and Nutrition Survey 2006 and 2012. We estimated the expected average weight reduction, stratified by category of sugar-sweetened beverages consumption. RESULTS: With a 10% tax, we estimated an overall weight reduction of 0.26 kg for children and 0.61 kg for adolescents; in high consumers, the reduction could reach 0.50 and 0.87 kg, respectively. Higher tax rates would produce larger weight decreases; in high consumers a 40% tax would result in a reduction of 1.99 kg for children and 3.50 kg for adolescents. CONCLUSION: The tax represents an effective component of any child or adolescent weight control program, and must be considered as part of any integrated population-level program for children and adolescent obesity prevention.

Mortality attributable to sugar sweetened beverages consumption in Mexico: an update.

BACKGROUND: In 2010, sugar sweetened beverages (SSBs) were estimated to cause 12% of all diabetes, cardiovascular disease (CVD) and obesity-related cancer deaths in Mexico. Using new risk estimates for SSBs consumption, we aimed to update the fraction of Mexican mortality attributable to SSBs, and provide subnational estimates by region, age, and sex. METHODS: We used an established comparative risk assessment framework. All-cause mortality estimates were calculated from a recent pooled cohort analysis. Age- and sex-specific relative risks for SSBs-disease relationships were obtained from updated meta-analyses. Demographics and nationally representative estimates of SSBs intake were derived from the National Health and Nutrition Survey 2012; and mortality rates, from the National Institute of Statistics and Geography. Attributable mortality was calculated by estimating the population attributable fraction of each disease, with uncertainty in data inputs propagated through Monte Carlo probabilistic sensitivity analyses. RESULTS: In Mexican adults 20 years and older, 6.9% (95%UI: 5.4-8.5) of all cause-mortality was attributable to SSBs, representing 40,842 excess deaths/year (95%UI: 31,950-50,138). Furthermore, 19% of diabetes, CVD and obesity-related cancer mortality was attributable to SSBs (95%UI: 11.0-26.5), representing 37,000 excess deaths/year (95%UI 21,240-51,045). Of these, 35.6% were diabetes-related (95%UI 16.4-52.0). Proportional burden was highest in the South (22.8%), followed by the Center (18.0%) and North (17.4%). Men aged 45-64-years in the Center region had highest proportional mortality (37.2%), followed by 20-44-year-old men living in the South (35.7%) and both men and women aged 20-44 living in the Center (34.4%). CONCLUSIONS: Utilizing current evidence linking SSBs to cardiometabolic disease and obesity-related cancers, earlier estimates of Mexican mortality attributable to SSBs could have been underestimated. Mexico urgently needs stronger policies to reduce SSBs consumption and reduce these burdens.

Correction: Expected changes in obesity after reformulation to reduce added sugars in beverages: A modeling study.

[This corrects the article DOI: 10.1371/journal.pmed.1002664.].

Expected changes in obesity after reformulation to reduce added sugars in beverages: A modeling study.

BACKGROUND: Several strategies have been proposed to reduce the intake of added sugars in the population. In Mexico, a 10% sugar-sweetened beverages (SSBs) tax was implemented in 2014, and the implementation of other nutritional policies, such as product reformulation to reduce added sugars, is under discussion. WHO recommends that all individuals consume less than 10% of their total energy intake (TEI) from added sugars. We propose gradually reducing added sugars in SSBs to achieve an average 10% consumption of added sugars in the Mexican population over 10 years and to estimate the expected impact of reformulation in adult body weight and obesity. METHODS AND FINDINGS: Baseline consumption for added sugars and SSBs, sex, age, socioeconomic status (SES), height, and weight for Mexican adults were obtained from the 2012 Mexico National Health and Nutrition Survey (ENSANUT). On average, 12.6% of the TEI was contributed by added sugars; we defined a 50% reduction in added sugars in SSBs over 10 years as a reformulation target. Using a dynamic weight change model, sugar reductions were translated into individual expected changes in body weight assuming a 43% caloric compensation and a 2-year lag for the full effect of reformulation to occur. Results were stratified by sex, age, and SES. Twelve years after reformulation, the TEI from added sugars is expected to decrease to 10%, assuming no compensation from added sugars; 44% of the population would still be above WHO recommendations, requiring further sugar reductions to food. Body weight could be reduced by 1.3 kg (95% CI -1.4 to -1.2) in the adult population, and obesity could decrease 3.9 percentage points (pp; -12.5% relative to baseline). Our sensitivity analyses suggest that the impact of the intervention could vary from 0.12 kg after 6 months to 1.52 kg in the long term. CONCLUSIONS: Reformulation to reduce added sugars in SSBs could produce large reductions in sugar consumption and obesity in the Mexican adult population. This study is limited by the use of a single dietary recall and by data collected in all seasons except summer; still, these limitations should lead to conservative estimates of the reformulation effect. Reformulation success could depend on government enforcement and industry and consumer response, for which further research and evidence are needed.