Soda Sugar Supertaxes Pave the Way for a Large Increase in Consumption of Sweeteners and Its Long‐Term Effects

ABSTRACT

As governments become aware of the increasing prevalence of obesity in their countries, they install taxes for the amount of sugar in sodas. This is leading to reductions in sugar intake and cardiovascular disease, as predicted, but unintentionally also to considerable increases in the consumption of non‐nutritive sweeteners (NNS). Since many studies on the safety of NNS are highly conflicting, it is unclear at present whether NNS are a healthy substitute for sugar.

1. Obesity Studies Drive Worldwide Political Tax Decisions Concerning the Sugar in Soda Beverages

The massively growing global obesity epidemic increases the risks of cardiovascular disease and cancer, turning obesity into a major public health problem. The economic consequences are disastrous, since the obesity‐associated health problems like those involving cardiovascular events have huge direct and indirect economic impacts, such as high medical costs and decreased productivity at work, respectively.

In their quest to fight obesity, governments from over 100 countries (and regional authorities in the United States and Canada) have installed a tax specific for the large amount of sugar (also known as sucrose and saccharose) contained within sugar‐sweetened beverages (SSB), aiming at a reduction of SSB sugar intake and a shift from the consumption of SSB toward water and other nontaxed drinks. Each country has chosen its own kind of SSB tax. Generally, taxes are based on retail price (“ad valorum tax”), as in most African countries, or rather on SSB volume or sugar content (“ad quantum tax”), as in Finland, Mexico, France, and Ecuador. These taxes can be dependent on a sugar concentration threshold or may even be combined, such as in Chile and Peru (sugar content‐dependent retail price tax) and the United Kingdom and France (sugar content‐dependent volume tax).

The SSB taxes are in line with a 2023 World Health Organization (WHO) guideline, advising a reduced intake of free sugars (sucrose, glucose, and fructose), specifically mentioning SSB, in order to reduce the risk of unhealthy weight gain [1]. It refers to studies pointing out that SSB are easily and quickly consumed and do not provide the same satisfying feeling of fullness that solid food provides. The unfortunate consequence is that SSB consumers do not reduce the intake of other foods in order to compensate for the SSB calories. Strikingly, in the same year, WHO released another note, recommending that low‐ and non‐caloric non‐nutritive sweeteners (NNS) should not be used as a means of achieving weight control. First, because the use of NNS would not prevent weight gain in the long term, and second, they could possibly display side effects [2].

Despite the latter WHO recommendation and likely due to the worldwide increasing SSB supertaxes, soda industries have already begun to substitute part of the sugar in non‐diet drinks for NNS (either stevia or both acesulfame K and sucralose), such as in Fanta, Orangina, 7UP, Pepsi, Schweppes, and Lipton iced tea, to name some (Figure 1). The tax‐escape benefit is evident, since in nearly all countries, sodas are minimally flat‐taxed for the NNS they contain or not taxed at all. What will be the next consequences? Possibly, in more and more non‐diet drinks, sugar may be replaced by NNS in order to reduce taxes. And probably, at some time in the near future, in a toughened battle of governments against the undeniable everlasting increase in obesity, also sugar‐laden foods like ice cream, fruit juices, flavored yogurt, pastries, and breakfast cereals may be supertaxed, potentially leading to more partial sugar‐sweetener substitutions.

FIGURE 1.

A range of sodas, divided in four subgroups. The drinks on the far left contain no sweetener but a lot of sugar and are therefore penalized by sugar supertaxes. In the two middle non‐diet groups, a part of the sugar has been substituted by sweeteners (tax reduction). Of these soda brands, sugar‐only versions no longer exist. Consumers are therefore confronted with the unsolicited consumption of NNS from their non‐diet drinks. The drinks on the far right contain sweeteners but no sugar at all and are well known as genuine diet or diabetes drinks. Of note, the packagings of all four groups display the amount of sugar and, if applicable, the presence (not the amount) of sweetener, in very small letters on the backside, causing a part of its consumers not to be aware of the NNS in their drinks. The partitioning of the displayed sodas in these four groups is based on their contents in France but is representative of the sugar‐sweetener swaps in over 100 countries.

2. NNS Consumption May Possibly Lead to Health Problems

The SSB taxes have significantly reduced sugar intake, which, by itself, is a very important feature since this reduces obesity, the related diseases, and dental caries. However, this tax has increased the consumption of NNS‐containing beverages, from +2% in Mexico up to +29% in California (+12.3% ± 10.9% on average in all published studies: six studies ranging from 2014 to 2020), raising questions about the NNS health effects. Unfortunately, it is difficult to have a clear‐cut objective insight into the beneficial versus harmful effects of NNS due to the many conflicting studies. Even the WHO‐mentioned absence of weight reduction in NNS users has been questioned [3]. Contrasting results have also been published concerning the possible negative effects of NNS on cancer [4], microbiome [5, 6], all‐cause mortality [7], and, paradoxically, on metabolic parameters [5, 8, 9], diabetes progression [9], and cardiovascular disease [7].

There are multiple reasons that could explain these contrasting findings. First of all, published studies are highly heterogeneous. For instance, important differences have been found between large observational cohort studies [4, 7] and clinical interventional randomized controlled trials (RCTs) [8, 9]. The type of NNS molecule studied is also likely to impact health effect outcome [4, 5], as well as the time of NNS treatment, with some studies lasting as short as 2 weeks [5, 8]. The amount of NNS intake obviously contributes to study outcome as well (for the moment, their amount is not even mentioned on food packagings). In addition, the number and type of study subjects impact the outcome (normal weight, overweight, obesity, or diabetes), as well as age, sex, skin color, baseline gut microbial composition, and country of residence. Altogether, it is evident that the effects of NNS on health remain a topic of debate. Unfortunately, almost all NNS studies describe short‐ or, at best, mid‐term effects, while long‐term NNS studies in humans are scarce. So it's too early to establish the long‐term side effects of the ingestion of NNS at sugar‐supertax‐driven concentrations. Since these molecules easily cross the placenta [10], what will be their effect on the unborn child? Taking the many unaddressed questions and alerting NNS studies into account, one can only conclude that soda sugar taxes successfully target sugar intake and obesity but unintentionally drive increases in NNS consumption (especially from non‐diet drinks), which warrants monitoring and potentially complementary policies. One policy may be NNS taxing as a means of discouraging the consumption of NNS‐containing beverages, as seen in Ecuador, France, India, and Portugal.

Importantly, it should be noted that there are numerous alternative (NNS‐independent) ways to tamper SSB consumption and obesity. First, access to potable water in public spaces, schools, and restaurants could be improved. Second, front‐of‐pack labeling of the amount of both sugar and NNS could be obliged, in order to discourage people from drinking SSB and NNS‐containing sodas altogether. Finally, education and communication concerning health improvement could be increased, encouraging improvements in physical activity and better eating habits, such as simply lowering calorie intake, intermittent fasting, and eating less ultraprocessed food but more fruits and vegetables.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analyzed during the current study.