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      The prospective impact of food pricing on improving dietary consumption: A systematic review and meta-analysis

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          Abstract

          Background

          While food pricing is a promising strategy to improve diet, the prospective impact of food pricing on diet has not been systematically quantified.

          Objective

          To quantify the prospective effect of changes in food prices on dietary consumption.

          Design

          We systematically searched online databases for interventional or prospective observational studies of price change and diet; we also searched for studies evaluating adiposity as a secondary outcome. Studies were excluded if price data were collected before 1990. Data were extracted independently and in duplicate. Findings were pooled using DerSimonian-Laird's random effects model. Pre-specified sources of heterogeneity were analyzed using meta-regression; and potential for publication bias, by funnel plots, Begg's and Egger's tests.

          Results

          From 3,163 identified abstracts, 23 interventional studies and 7 prospective cohorts with 37 intervention arms met inclusion criteria. In pooled analyses, a 10% decrease in price (i.e., subsidy) increased consumption of healthful foods by 12% (95%CI = 10–15%; N = 22 studies/intervention arms) whereas a 10% increase price (i.e. tax) decreased consumption of unhealthful foods by 6% (95%CI = 4–8%; N = 15). By food group, subsidies increased intake of fruits and vegetables by 14% (95%CI = 11–17%; N = 9); and other healthful foods, by 16% (95%CI = 10–23%; N = 10); without significant effects on more healthful beverages (-3%; 95%CI = -16-11%; N = 3). Each 10% price increase reduced sugar-sweetened beverage intake by 7% (95%CI = 3–10%; N = 5); fast foods, by 3% (95%CI = 1–5%; N = 3); and other unhealthful foods, by 9% (95%CI = 6–12%; N = 3). Changes in price of fruits and vegetables reduced body mass index (-0.04 kg/m 2 per 10% price decrease, 95%CI = -0.08–0 kg/m 2; N = 4); price changes for sugar-sweetened beverages or fast foods did not significantly alter body mass index, based on 4 studies. Meta-regression identified direction of price change (tax vs. subsidy), number of intervention components, intervention duration, and study quality score as significant sources of heterogeneity (P-heterogeneity<0.05 each). Evidence for publication bias was not observed.

          Conclusions

          These prospective results, largely from interventional studies, support efficacy of subsidies to increase consumption of healthful foods; and taxation to reduce intake of unhealthful beverages and foods. Use of subsidies and combined multicomponent interventions appear most effective.

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          Most cited references36

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          A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010

          The Lancet, 380(9859), 2224-2260
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            The impact of food prices on consumption: a systematic review of research on the price elasticity of demand for food.

            In light of proposals to improve diets by shifting food prices, it is important to understand how price changes affect demand for various foods. We reviewed 160 studies on the price elasticity of demand for major food categories to assess mean elasticities by food category and variations in estimates by study design. Price elasticities for foods and nonalcoholic beverages ranged from 0.27 to 0.81 (absolute values), with food away from home, soft drinks, juice, and meats being most responsive to price changes (0.7-0.8). As an example, a 10% increase in soft drink prices should reduce consumption by 8% to 10%. Studies estimating price effects on substitutions from unhealthy to healthy food and price responsiveness among at-risk populations are particularly needed.
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              Evidence that a tax on sugar sweetened beverages reduces the obesity rate: a meta-analysis

              Background Excess intake of sugar sweetened beverages (SSBs) has been shown to result in weight gain. To address the growing epidemic of obesity, one option is to combine programmes that target individual behaviour change with a fiscal policy such as excise tax on SSBs. This study evaluates the literature on SSB taxes or price increases, and their potential impact on consumption levels, obesity, overweight and body mass index (BMI). The possibility of switching to alternative drinks is also considered. Methods The following databases were used: Pubmed/Medline, The Cochrane Database of Systematic Reviews, Google Scholar, Econlit, National Bureau of Economics Research (NBER), Research Papers in Economics (RePEc). Articles published between January 2000 and January 2013, which reported changes in diet or BMI, overweight and/or obesity due to a tax on, or price change of, SSBs were included. Results Nine articles met the criteria for the meta-analysis. Six were from the USA and one each from Mexico, Brazil and France. All showed negative own-price elasticity, which means that higher prices are associated with a lower demand for SSBs. Pooled own price-elasticity was -1.299 (95% CI: -1.089 - -1.509). Four articles reported cross-price elasticities, three from the USA and one from Mexico; higher prices for SSBs were associated with an increased demand for alternative beverages such as fruit juice (0.388, 95% CI: 0.009 – 0.767) and milk (0.129, 95% CI: -0.085 – 0.342), and a reduced demand for diet drinks (-0.423, 95% CI: -0.628 - -1.219). Six articles from the USA showed that a higher price could also lead to a decrease in BMI, and decrease the prevalence of overweight and obesity. Conclusions Taxing SSBs may reduce obesity. Future research should estimate price elasticities in low- and middle-income countries and identify potential health gains and the wider impact on jobs, monetary savings to the health sector, implementation costs and government revenue. Context-specific cost-effectiveness studies would allow policy makers to weigh these factors.
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                Author and article information

                Contributors
                Role: Editor
                Journal
                PLoS One
                PLoS ONE
                plos
                plosone
                PLoS ONE
                Public Library of Science (San Francisco, CA USA )
                1932-6203
                1 March 2017
                2017
                : 12
                : 3
                : e0172277
                Affiliations
                [1 ]Institute for Health Metrics and Evaluation, University of Washington, Seattle, WA, United States of America
                [2 ]Friedman School of Nutrition Science & Policy, Tufts University, Boston, MA, United States of America
                [3 ]School of Medicine, Stanford University, Stanford, CA, United States of America
                [4 ]Department of Cardiology, Boston Medical Center, Boston, MA, United States of America
                [5 ]School of Medicine, Tufts University, Boston MA, United States of America
                [6 ]Department of Public Health and Policy, University of Liverpool, Liverpool, United Kingdom
                [7 ]Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
                [8 ]Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
                [9 ]Department of Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
                [10 ]Department of Nutrition, Harvard T.H. Chan School of Public Health, Boston, MA, United States of America
                University of Cambridge, UNITED KINGDOM
                Author notes

                Competing Interests: DM reports ad hoc travel reimbursement or honoraria from Bunge, Pollock Institute, Quaker Oats, and Life Sciences Research Organization; ad hoc consulting fees from McKinsey Health Systems Institute, Foodminds, Nutrition Impact, Amarin, Omthera, and Winston and Strawn LLP; membership, Unilever North America Scientific Advisory Board; royalties from UpToDate; and research grants from GlaxoSmithKline, Sigma Tau, Pronova, the Gates Foundation, the Sackler Institute of Nutrition, and the National Institutes of Health. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

                • Conceptualization: AA DM.

                • Data curation: AA JP LDG JS MM.

                • Formal analysis: AA JP DM.

                • Funding acquisition: DM.

                • Methodology: AA DS GD DM.

                • Writing – original draft: AA DM.

                • Writing – review & editing: AA JP LDG JS MM MO SC DS GD DM.

                ‡ These authors are co-first authors on this work.

                Article
                PONE-D-16-12254
                10.1371/journal.pone.0172277
                5332034
                28249003
                ef82bfd0-25a2-4e40-8bb3-19a6e851071a
                © 2017 Afshin et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 29 March 2016
                : 2 February 2017
                Page count
                Figures: 2, Tables: 3, Pages: 18
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/100000050, National Heart, Lung, and Blood Institute;
                Award ID: R01 HL115189
                Award Recipient :
                Funded by: funder-id http://dx.doi.org/10.13039/100000050, National Heart, Lung, and Blood Institute;
                Award ID: T32 HL098048
                Award Recipient :
                Funded by: New York Academy of Sciences' Sacker Institute
                Award Recipient :
                AA was supported by T32 HL098048 from the National Heart, Lung, and Blood Institute. DM was supported by R01 HL115189 from the National Heart, Lung, and Blood Institute and a Research Award from The New York Academy of Sciences' Sacker Institute for Nutrition Science. JP was partly supported by a Bunge Fellowship in Global Nutrition. DM reports ad hoc travel reimbursement or honoraria from Bunge, Pollock Institute, Quaker Oats, and Life Sciences Research Organization; ad hoc consulting fees from McKinsey Health Systems Institute, Foodminds, Nutrition Impact, Amarin, Omthera, and Winston and Strawn LLP; membership, Unilever North America Scientific Advisory Board; royalties from UpToDate; and research grants from GlaxoSmithKline, Sigma Tau, Pronova, the Gates Foundation, the Sackler Institute of Nutrition, and the National Institutes of Health. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.
                Categories
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                Biology and Life Sciences
                Nutrition
                Diet
                Food
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                Nutrition
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                Biology and Life Sciences
                Physiology
                Physiological Processes
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                Physiology
                Physiological Processes
                Food Consumption
                Biology and Life Sciences
                Nutrition
                Medicine and Health Sciences
                Nutrition
                Biology and Life Sciences
                Nutrition
                Diet
                Medicine and Health Sciences
                Nutrition
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                Nutrition
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                Social Sciences
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