Sugar-sweetened beverage regulations and nutrient profiling models in five South Asian countries: a scoping review of available evidence and policy gaps

Abstract

Background

Sugar-sweetened beverages (SSBs) contribute to the rising burden of non-communicable diseases in South Asia. Evidence on existing regulatory approaches and the use of nutrient profiling models (NPMs) remains fragmented. This scoping review maps available evidence on SSB regulation in five South Asian countries.

Methods

We conducted a scoping review following Joanna Briggs Institute guidance and PRISMA-ScR. Seven databases and grey literature were searched for studies published up to January 2025. Eligible sources examined SSB-related regulatory approaches in Bangladesh, India, Nepal, Pakistan, and Sri Lanka. Data were charted and synthesised across taxation, labelling, marketing and availability restrictions.

Results

Seventeen studies were included. Taxation was the most frequently reported policy, implemented mainly as ad valorem or category-based taxes, except in Sri Lanka where a sugar-based excise tax was applied. Labelling, marketing, and availability restrictions were limited and unevenly implemented. Only four studies reported the use of NPMs, largely confined to Sri Lanka. Evidence on policy effectiveness, enforcement, and equity impacts was limited. Industry interference and weak regulatory capacity were commonly reported barriers.

Conclusion

SSB regulation in South Asia is dominated by taxation, with limited use of nutrient-based approaches and weak implementation of complementary measures. Strengthening policy design, enforcement, and evidence on effectiveness is critical to advance SSB control in the region.

Supplementary Information

The online version contains supplementary material available at https://doi.org/10.1186/s40795-026-01444-8.

Background

Sugar-sweetened beverages (SSBs, including sodas, sweetened teas, and sports, fruit, and energy drinks) [1] are major sources of added sugars in daily diets and contribute to adverse health outcomes [2–5]. Energy-dense, nutrient-poor foods and drinks negatively affect health, with SSB consumption associated with obesity, type 2 diabetes, cardiovascular diseases and hypertension [6]. Rising obesity and non-communicable diseases are concerns in South Asian countries [7]. Bangladesh, Nepal, and Sri Lanka are among the countries with the most rapid rise in obesity, while India and Pakistan are predicted to have the highest prevalence of adult obesity by 2030 [7–9].

SSBs have gained popularity across all age groups; however, adolescents and children have become major consumers and vulnerable targets [10, 11]. In Bangladesh’s capital, Dhaka, 48% school children drink soft drinks daily [12]. Among school-going adolescents in Nepal, 33.3% consume carbonated soft drinks once or twice daily [13]. Evidence from a national survey among adolescents in Pakistan reported that 70.5% have high (> 7 times/week) total SSB intake [14]. Weak regulations, appealing advertising, celebrity endorsements, widespread availability, low prices, and misleading packaging drive this increased consumption [15]. SSB taxes and front-of-pack (FOP) health warnings are effective in reducing SSB intake [16–20]. Accordingly, SSB taxation, restricting marketing to children, interpretative FOP nutrition labels, and awareness campaigns are recommended to reduce SSB consumption [6, 16]. Nutrient profiling models (NPMs) provide objective nutrient criteria that translate nutrition science into regulatory tools and have increasingly been used to guide SSB taxation, front-of-pack labelling (FOPL), and marketing restrictions [21–23]. By harmonising nutrient thresholds across policy instruments, NPMs can improve policy coherence and encourage product reformulation [22, 24]. However, inconsistent or absent NPM application may weaken the effectiveness of regulatory measures and create opportunities for industry circumvention [24].

South Asian countries are implementing tax and regulatory policies to combat rising SSB consumption. SSB tax in Pakistan was increased from 13% to 20% in 2023 [25]. Sri Lanka introduced Traffic Light Labelling (TLL) in 2016 and excise tax on SSB in 2017 [26]. India implemented 28% tax on aerated drinks in 2017 [27]. In Bangladesh, all SSB’s are subject to 15% value added tax [28]. Also, imported SSBs are taxed at 150% while domestic carbonated and energy drinks, respectively, face 25% and 35% supplementary duty since 2012 [28]. Nepal applies volume and product category-based excise tax on SSBs (Nepalese Rupee (NPR) 25 per litre for carbonated drinks, 13.5 for fruit juice, 52 for energy drinks) [29].

Despite these regulatory efforts, measures remain fragmented and are often implemented without common nutrient criteria. Since NPMs underpin several regulatory instruments, including taxation, FOPL and marketing restrictions, their design and application are important determinants of policy coherence and effectiveness. Research in these countries examined SSB consumption, it’s awareness, prevalence, determinants, price elasticity, health outcome, crowding out effect, taxation, packaging and labelling [14, 26, 30–38]. Nevertheless, there is a dearth of evidence assessing the current SSB regulations and NPMs to identify the regulatory gaps for controlling SSB consumption. This scoping review gauges the current landscape of food nutrient profiling and SSB regulations across five South Asian countries (Bangladesh, India, Nepal, Pakistan, and Sri Lanka), which account for the majority of the region’s population and share broadly comparable nutrition transition and regulatory contexts. We examined how SSB regulations are framed, the NPMs used, and their alignment with current needs. The findings aim to support evidence-informed policy development and facilitate greater regional learning and harmonisation of SSB regulations in South Asia by identifying gaps in existing regulatory approaches and NPM use.

Methods

Study design and question formulation framework

We conducted a scoping review following Joanna Briggs Institute (JBI) guidelines to systematically map regulatory strategies and the use of NPMs to regulate SSB consumption in Bangladesh, Nepal, Pakistan, India, and Sri Lanka [39]. Following JBI guideline, we considered a scoping review because the objective was to map the diverse evidence (including peer-reviewed articles, policy documents and grey literature) rather than evaluate policy effectiveness [39, 40]. Due to its exploratory nature and heterogeneity in evidence and methods, this approach was appropriate for identifying and synthesising the scope, characteristics, and gaps within the evidence. The review question, guided by the Population-Concept-Context (PCC) framework [41], was: “What regulatory approaches and NPMs are used to regulate SSB consumption in these countries?” Considering the contextualities involved in this research we selected PCC framework. The corresponding PCC specification of the review question is presented in the supplementary file, Table S1, pp 2.

Reporting framework, search strategy and information sources

We followed the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension for Scoping Reviews (PRISMA-ScR) as reporting framework [42]. All review stages were guided by a pre-established protocol (Supplementary File, Protocol, pp 2); however, due to the exploratory and mapping nature of the review, the protocol was not registered. We maintained transparency by adhering to JBI methodological and PRISMA-ScR reporting standards (Supplementary File, PRISMA-ScR checklist, pp 13), including documentation of any protocol deviations.

An exhaustive search strategy tailored for each database was developed through iterative team discussion. Search terms were organised into thematic groups: (1) sugar-sweetened beverages, (2) geographic location, (3) regulation and policy, (4) nutrient profiling models, (5) packaging and labelling, (6) taxation and fiscal measures, and (7) regulatory challenges such as tax evasion or counterfeit products. Table S2 (Supplementary File, pp 7) contains the domain-specific search terms. We used a blend of free text and Medical Subject Headings (MeSH) terms, applying wildcards, truncation, and Boolean operators to optimise the search process. The search strings are publicly available elsewhere [43].

We searched seven electronic databases (PubMed, Embase, APA PsycInfo, MEDLINE via Ovid, Web of Science (core collection), CINAHL and EconLit). Due to the limited volume of policy and regulation-focused evidence from these sources, and to include grey literature, we also performed backward reference searches. A guided search on Google Scholar was conducted to identify regulatory documents, policy analyses, and other regionally grounded evidence, including documents hosted on government and international organisation websites. Google Scholar searches used domain-specific terms along with the names of individual countries. The first ten pages of results were screened for relevance, and all potentially eligible records were assessed using the same inclusion criteria as peer-reviewed studies. English was used as the language restriction in the search string. The search included evidence published from January 2014 to January 2025. Table S3 (Supplementary File, pp 8) contains the completed search strategy and results for PubMed.

Study eligibility, selection, data extraction and quality assessment

Inclusion and exclusion criteria, screening, and study selection

Study eligibility criteria were defined a priori using the PCC framework. Details of the inclusion and exclusion criteria are summarised in Table S4 (Supplementary File, pp 9). We included studies addressing regulatory and policy approaches to control SSB consumption, including taxation, nutrition labelling, marketing restrictions, availability controls, and the use of NPMs to inform these measures. Studies focusing exclusively on SSB consumption or health outcomes without explicit policy linkage were excluded. We limited the review to national-level regulatory frameworks in the selected countries. Eligible sources included peer-reviewed articles, government laws and regulations, policy documents, and relevant grey literature. We applied common eligibility criteria to all evidence sources.

We de-duplicated the retrieved records using reference management software (Zotero) [44]. Study selection was conducted in two stages: title and abstract screening, followed by full-text screening. We used Rayyan software to manage studies in the screening stage [45]. Applying the eligibility criteria, reviewers (TFC, PJ, MM and SS) screened titles and abstracts. Studies not meeting the inclusion criteria were excluded, but uncertain ones were retained for full-text screening. In stage two, reviewers (SMA, TFC, PJ, MM and SS) screened the full-text of the studies and confirmed their inclusion in the review. Selection responses were recorded using a pre-developed full-text screening form (Supplementary File, Table S5, pp 10). Exclusion reasons at the full-text screening stage were recorded. In all stages, reviewers screened the studies independently, and disagreements were resolved through discussion and consensus among the reviewers.

Data extraction and quality assessment

We adapted the JBI data extraction tool for the scoping review, pre-piloted and finalised it through iterative team reviews (Supplementary File, Table S6, pp 11) [39]. We extracted information related to study characteristics (author, country, publication year, study type and setting, study design), type of regulatory measure (taxation, packaging and labelling, marketing and availability restriction), description of NPMs, regulatory objectives and scope, enforcement mechanisms and responsible authorities, implementation challenge and regulatory gaps, policy effectiveness and compliance. Four reviewers (Bangladesh: TFC, Sri Lanka: PJ, Pakistan: MM and Nepal: SS) conducted independent data extraction. To maintain consistency and completeness, each team cross-examined another team’s extraction. Discrepancies were addressed through discussion and consensus among the reviewers. As quality assessment is not required for scoping reviews [46], and our research is exploratory and involved regulatory mapping, we did not critically appraise the quality of the studies included in the review.

Data synthesis

We followed the synthesis plan outlined in the scoping review protocol (Supplementary File, Protocol, pp 3). Data were synthesised through descriptive numerical mapping and narrative thematic analysis. We used descriptive summaries to map studies by characteristics and coverage of four policy components (taxation, labelling, marketing and availability restrictions). For thematic analysis, we developed an analytical framework based on these components, incorporating contextual and analytical variables such as country context, population focus, regulatory instruments, and outcome domains to facilitate cross-study comparisons. Studies were mapped onto the framework and classified under relevant components. We conducted a narrative synthesis for each policy area, highlighting key themes, similarities, and differences across countries. A cross-cutting synthesis compared policy approaches, identified gaps between intent and implementation, examined complementarities among instruments, and highlighted evidence gaps.

Results

Study selection

We found 467 records through database and reference search. After deduplication (n = 191) we screened 276 records for titles and 95 records for abstracts. Using eligibility criteria, we selected 37 records for full-text screening. Of these, 20 records were excluded [different outcome (n = 9), different population (n = 10), different study design (n = 1)], and 17 records were considered for data extraction and narrative synthesis. Figure 1 contains the study selection summary in the PRISMA-ScR flow diagram.

Fig. 1.

PRISMA-ScR flow diagram

Study characteristics

Tables 1 and 2 summarises the 17 studies in the review. Eight studies used a multi-country approach [47–54], while 9 focused on individual countries [26, 27, 36, 55–60]. India was the most studied (n = 8) [26, 27, 48, 49, 52, 53, 55, 56], followed by Bangladesh (n = 5) [48, 52, 54, 58, 59], Sri Lanka (n = 4) [26, 36, 47, 52], Pakistan (n = 3) [52, 54, 57], and Nepal (n = 2) [52, 54]. The studies were mainly: peer-reviewed articles (n = 15) [26, 27, 47, 49–60], and technical and policy reports from agencies and research institutions (n = 2) [36, 48]. Out of 17 studies 15 addressed taxation; [26, 27, 36, 47–50, 52–57, 59, 60] fewer examined packaging and labelling (n = 12) [26, 27, 47, 48, 51, 52, 54–56, 58–60], marketing (n = 9) [26, 27, 47, 48, 50, 51, 56, 58, 59], or availability restrictions (n = 6) [36, 48–51, 58].

Table 1.

Characteristics of studies included in the review

SL	Citation (Author, Year)	Country / Setting	Study Aim / Objective	Study Design / Methodology	Population / Sample	Data Source / Data Collection Method	Key Variables / Focus Area
1	Avirneni et al., 2023 [50]	Global including Sri Lanka	Discuss the effectiveness and global evolution of SSB taxes	Review (Narrative)	General population	Secondary data	SSB taxation
2	Huque et al., 2024 [59]	Bangladesh	Estimate own-price elasticities of demand for SSBs	Quantitative	National households	Secondary data (HIES 2016)	SSB consumption and taxation
3	John et al., 2022 [55]	India	Estimate price elasticities and examine trends in ASB affordability	Quantitative	National households	Secondary data (NSSO; retail prices)	SSB consumption, taxation, and affordability
4	Kelly et al., 2013 [51]	Global including LMIC	Identify approaches for monitoring food promotions to children	Review / Framework development	Children	Media platforms and literature	Marketing
5	Kharbanda et al., 2018 [56]	India	Identify gaps in action and advocacy against excessive sugar consumption	Qualitative study	Policy experts and stakeholders	Expert deliberations	Sugar consumption and NCD prevention
6	Law et al., 2021 [27]	India	Investigate purchase changes post-GST implementation	Quasi-experimental (Interrupted time series)	Urban households	Secondary data (Household panel purchase records)	SSB taxation
7	Lwin et al., 2023 [54]	LMICs including Bangladesh, Nepal and Pakistan	Explore the political economy and framing of health taxes	Qualitative study (Case studies)	Policy actors and media	Interviews and media analysis	Health taxes
8	Madurawala et al., 2023 [26]	Sri Lanka	Analyse political economy influences on SSB tax and labelling	Qualitative study (Case study)	Policy stakeholders	Interviews and policy documents	SSB taxation and labelling
9	Mandal et al., 2020 [60]	India	Assess awareness and perceptions regarding SSB taxation and warnings	Cross-sectional	Clinic visitors (patients and accompanying persons)	Interviews	SSB taxation and labelling
10	Mirza and Munir, 2023 [57]	Pakistan	Analyse institutional and political deficiencies in health tax regimes	Mixed-methods	Policy stakeholders and media	Interviews and media analysis	Health taxes
11	Muhammad et al., 2019 [52]	164 countries including Bangladesh, India, Pakistan, Nepal and Sri Lanka	Quantify global SSB intake responsiveness to prices	Quantitative	Adult population	Secondary data (Global Dietary Database; World Bank)	SSB consumption and taxation
12	Nakhimovsky et al., 2016 [53]	MICs including India	Assess the effectiveness of SSB taxation on obesity and demand	Systematic review	General population	Peer-reviewed and grey literature	SSB taxation
13	Shaheen et al., 2024 [58]	Bangladesh	Identify nutrient content and label conformity of processed foods	Cross-sectional	Processed packaged food products	Laboratory analysis of market samples	Nutritional disclosure and labelling
14	Tassy et al., 2024 [47]	LMICs including Sri Lanka	Review government-endorsed nutrient profiling models	Systematic review	Nutrient profiling models (NPMs)	Peer-reviewed and grey literature	Nutrient profiling
15	Taylor and Jacobson, 2016 [48]	41 LMICs including Bangladesh, Nepal and India	Analyse marketing strategies and health impacts of SSBs	Qualitative study (Technical report)	SSBs and industry	Industry documents and literature	Marketing and health impacts
16	World Health Organization, 2018	Sri Lanka	Provide technical assistance for implementing SSB fiscal policies	Mixed-methods (Technical report)	National population	Secondary data and stakeholder discussions	SSB taxation
17	Wright et al., 2017 [49]	85 countries including India	Synthesize empirical evidence on health tax design and impact	Systematic review	Health taxes on unhealthy products	Peer-reviewed and grey literature	Health taxes

Table 2.

Data extraction and summary of included studies

SL	Citation (Author, Year)	Taxation	Packaging & Labelling	Marketing Restriction	Availability Restriction	Nutrient Profiling Model (NPM)
1	Avirneni et al., 2023 [50]	Reduces consumption via price increases; high pass-through rates essential for effective prevention.	Serves a “signalling effect” to deliver health messages.	Research on marketing in LMICs identified as a priority.	Propose local policies to prevent sales in schools and sporting arenas.	Not specified
2	Huque et al., 2024 [59]	10% price increase via taxes predicted to reduce soft drink consumption by 11.7%.	Standard classification of drinks based on sugar content recommended.	Not found	SSBs affordable due to availability in multiple-sized packs and bottles.	Not specified
3	John et al., 2022 [55]	10% price increase reduces ASB consumption by 9.4%; current 40% GST largely ineffective due to low real price increases.	Product classification distinguishing between drinks with and without added sugar recommended.	Not found	Not found	Not specified
4	Kelly et al., 2013 [51]	Not relevant	On-pack assessment including presence of promotional characters and nutrition claims.	Framework for monitoring TV, internet, and outdoor advertising exposure.	Includes monitoring product availability in school food environments.	FSA (UK) model used for restricting broadcast advertising.
5	Kharbanda et al., 2018 [56]	28% GST cess should expand to all high-sugar food products; tax revenue often earmarked for health.	Nutrition labels must explicitly mention added sugars; health warnings anticipated as a future necessity.	Policy on industrial marketing and reformulation needs development.	Global trends show significant increases in portion sizes.	Not specified
6	Law et al., 2021 [27]	40% GST in India showed no evidence of reduced purchases due to low price pass-through (3.7%).	GST lacked a “signalling effect” as it was not framed as a health measure.	Industry used strong marketing campaigns to witness volume recovery post-GST.	Not found	Not specified
7	Lwin et al., 2023 [54]	Health framing (suffering/death) vs. economic framing (revenue/jobs) used to shape policy.	Graphic appeals to bodily harm on packaging can enhance effectiveness of health messages.	Opponents use sophisticated media strategies to block health taxes.	Not found	Not specified
8	Madurawala et al., 2023 [26]	Sugar-based tax (2017) led to sales drops; intense industry lobbying reduced rates from 50 to 30 cents/gram.	Traffic light labelling (TLL) implemented in 2016; industry requested grace periods for label printing.	Industry advertising and sponsorships can challenge policy implementation.	Not found	Threshold-based (e.g., Red label for sugar > 11 g/100 ml).
9	Mandal et al., 2020 [60]	66.2% of participants would decrease consumption if taxes increased; 58.9% opposed to tax increments.	96.6% support health warnings; 69.3% prefer combined textual and pictorial warnings.	Public awareness suggested via social media, TV, and newspapers.	81.9% would prefer homemade beverages if tax increases.	Not relevant
10	Mirza and Munir, 2023 [57]	Institutional fragmentation allows industry to facilitate tax rate reductions.	Industry violations of mandatory health warnings documented.	Distribution of free samples used to bypass marketing laws.	Countrywide legal crackdown and ban on specific public activities (e.g., shisha).	Not relevant
11	Muhammad et al., 2019 [52]	20% tax most effective in low-income countries; intake reduction reaches up to 24.9% for specific subgroups.	Combine taxes with food labelling and education in high-income countries to change behaviour.	Not found	Not found	Not relevant
12	Nakhimovsky et al., 2016 [53]	Own-price elasticity in MICs ranges − 0.6 to -1.2; minimum 20% price increase needed to halt obesity.	Monitoring of manufacturer packaging changes required; traffic light labelling is cost-effective.	Not found	Not found	Traffic light nutrition labelling (evaluated for cost-effectiveness).
13	Shaheen et al., 2024 [58]	Not found	100% non-compliance in sugar/salt reporting; 46% of products missing saturated fat info.	Not found	Propose national ban on unhealthy packaged foods.	Health Star Rating (0.5–2.5 range) and UK Traffic Light scheme.
14	Tassy et al., 2024 [47]	Fiscal policies in Ethiopia (2020) and Colombia (2022) utilize NPMs.	18 government-endorsed NPMs in LMICs; Warning Labels and Healthier Choice Logos are most common.	NPMs used for advertisement regulations in Bolivia.	Not found	Scoring or threshold models (e.g., PAHO, Choices, Nutri-Score).
15	Taylor and Jacobson, 2016 [48]	Recommends excise taxes boosting prices by at least 10% to 20%.	Recommends mandatory, easily understood nutrition labels and health warnings on containers.	Propose barring advertising targeted at children on internet and mobile platforms.	Bar SSB sales in schools and government property; limit portion sizes to 500 ml.	Not specified
16	WHO, 2018	Specific excise taxes based on sugar content are superior for incentivizing reformulation.	Recommends interpretative front-of-pack labelling to guide consumers.	Recommends implementing global recommendations on marketing to children.	Propose school-based interventions including subsidizing healthy snacks and prohibiting unhealthy ones.	Not specified
17	Wright et al., 2017 [49]	Taxes of 20% or more most likely to change health behaviours; specific taxes superior to ad valorem.	Transparency of gross price on the shelf significantly affects consumer sensitivity to taxes.	Industry interests dominate media coverage to oppose health taxes.	Restricting vending machine access shown to be effective for child obesity.	Not specified

Evidence mapping across policy components and narrative synthesis

Evidence mapping showed that 2 studies addressed a single policy component [53, 57], while 15 examined multiple components [26, 27, 36, 47–52, 54–56, 58–60]. Taxation was the most commonly addressed policy component across the countries, and NPMs were occasionally described, with considerable cross-country variation.

Taxation

SSB taxation was included in 15 articles with design variations across countries. Sri Lanka (n = 4) adopted a sugar content-based tax using nutrient thresholds, applying excise taxes to beverages exceeding sugar limits per 100ml [26, 36, 47, 52]. Conversely, India (n = 10) [27, 48–50, 52–56, 60], Bangladesh (n = 4) [50, 52, 54, 59], and Pakistan (n = 3) [52, 54, 57], relied on ad valorem or category-based taxes through broader fiscal systems. India’s Goods and Services Tax (GST) applied different rates by product rather than sugar content. Bangladesh and Pakistan imposed supplementary duties on selected beverage categories, with differences for imported and domestic products. Across these countries, several sources reported that SSB taxation was mostly framed as a revenue measure (n = 7) rather than as a public health intervention [36, 49, 53–55, 57, 59]. Studies rarely referred to potential earmarking of revenues for health or nutrition programmes [56], with no evidence of sustained practice. Nine studies documented political, legal, and industry responses, highlighting opposition, lobbying, legal challenges, and political constraints that influenced tax design, weakened nutrient-based structures, or delayed implementation, particularly in India and Sri Lanka [26, 27, 48–50, 53, 54, 57, 60]. Evidence from Nepal (n = 2) was limited [52, 54], with no documented SSB-specific or nutrient-based tax.

Packaging and labelling

Evidence on SSB labelling policies was found in twelve studies [26, 27, 47, 48, 51, 52, 54–56, 58–60]. Sri Lanka (n = 3) implemented an obligatory TLL system for SSBs, based on sugar thresholds, representing the most explicit operational use of NPM in South Asia [26, 47, 52]. In India (n = 7) [27, 48, 51, 52, 55, 56, 60] and Bangladesh (n = 5) [51, 52, 54, 58, 59], mandatory nutrition declarations exist under general food labelling laws; however, no standardised FOP interpretive labelling for SSBs has been implemented. Evidence from Bangladesh raised concerns regarding label accuracy and enforcement, noting discrepancies between declared and laboratory-measured nutrient content. For Pakistan (n = 2) [52, 54] and Nepal (n = 2) [52, 54], evidence was scarce and limited to proposed alignment with international guidance, with no documented implementation of SSB-specific labelling regulations.

Marketing restrictions

Nine studies included marketing restrictions on SSB [26, 27, 47, 48, 50, 51, 56, 58, 59]. Sri Lanka (n = 2) developed nutrient profiling-based guidance to limit marketing to children, but gaps in implementation and enforcement were noted [26, 47]. In other countries, restrictions were absent or part of broader advertising laws without specific nutrient criteria. India and Bangladesh relied on general advertising regulations [27, 48, 50, 51, 56, 58, 59], while Pakistan and Nepal lacked documented SSB-specific controls. Studies covering Bangladesh and India highlighted that digital and social media marketing largely remain unregulated, especially for children and adolescents. No country-specific evaluations of reductions in marketing exposure, compliance, or enforcement effectiveness were identified.

Availability restrictions

Availability restrictions were the least frequently addressed policy component among the studies included in the review (n = 6) [36, 48–51, 58]. SSB sales restrictions in settings such as schools, healthcare facilities, or government institutions appeared in policy recommendations or national nutrition strategies, rather than as enforceable, SSB-specific regulations. Sri Lanka (n = 1) showed limited institutional-level availability restrictions aligned with broader healthy-diet initiatives, with no reported systematic enforcement evaluation [36]. In India (n = 4), such restrictions were mainly discussed within broader school nutrition or food environment policies, without enforceable provisions targeting SSBs [48–51]. In Bangladesh, Nepal, and Pakistan, these restrictions were mostly absent, and no studies reported systematic enforcement or impact assessments in institutional settings.

Nutrient profiling models: Cross-country comparison

Application of NPMs for SSB regulation was found in four studies [26, 36, 47, 58]. Sri Lanka (n = 3) used sugar-content thresholds to determine tax liability, inform TLL, and guide marketing restrictions for children [26, 36, 47]. These thresholds were broadly informed by the nutrient profiling approaches recommended by the World Health Organization (WHO) Europe and the Pan American Health Organisation (PAHO) NPMs, while being adapted to the Sri Lankan regulatory context [21, 22, 61]. Conversely, Bangladesh, India, Nepal, and Pakistan lacked standardised, enforceable NPMs specific to SSBs. While references to sugar reduction appeared in dietary guidelines, general labelling regulations, or policy discussions, only Sri Lanka applied numeric nutrient thresholds consistently across tax, labelling, and marketing restrictions. Other countries used category or value-based approaches predominantly for taxation and labelling, which several sources suggested could limit policy precision and enable SSB industry circumvention.

Cross-cutting findings and evidence gaps

Most studies (n = 7) documented a gap between regulatory intent and implementation across policy components and countries, mainly due to weak enforcement, limited monitoring, and fragmented governance [26, 27, 48, 49, 54, 57, 58]. Regarding taxation, labelling, and marketing restrictions, SSB industry interference and political economy constraints were common barriers across countries. In Nepal (n = 2) [52, 54], evidence was mostly indirect or comparative, indicating a considerable evidence gap. Across countries, marketing (n = 8) [26, 27, 47, 48, 51, 56, 58, 59] and availability (n = 5) [36, 48, 49, 51, 58] restrictions were sparsely addressed and rarely supported by enforcement evidence. Differential impacts on children, adolescents, or low-income populations were mentioned in few studies but were seldom examined empirically. Similarly, few studies reported outcomes related to SSB consumption, reformulation, or consumer understanding, highlighting the limited evaluative evidence for SSB regulation in the reviewed countries.

Discussion

Our review mapped SSB regulatory approaches and NPMs use in five South Asian countries. We found that SSB taxation as the most frequently examined regulatory measure in the included literature in these countries, while labelling, marketing and availability restrictions are less developed and unevenly implemented. NPMs were seldom used in policy design, with Sri Lanka the only country that applied nutrient thresholds across regulatory instruments. Evidence on the implementation and effectiveness of existing SSB policies was limited across countries, with few evaluations mostly from Sri Lanka.

Similar regulatory asymmetries were observed beyond South Asia, where tax measures were implemented earlier than broader nutrition regulations due to their administrative feasibility and revenue potential [6, 18–20]. However, tax structure is as important as tax adoption. In Mexico, a specific excise tax based on sugar content led to sustained price increases and significant reductions in SSB purchases, particularly among lower-income households [19, 20]. Evidence also suggests that well-designed taxes can reduce consumption and shift demand to untaxed alternatives, with 6–10% declines observed in Mexico alongside increased purchases of healthier beverages [19, 20]. Similarly, in UK tiered sugar based taxes incentivised product reformulation [18]. Sri Lanka’s sugar content based taxation connects tax liability directly to sugar content and creates reformulation incentive. Conversely, ad valorem and category based SSB taxes in Bangladesh, India and Pakistan show limited reformulation incentives and opportunities for product substitution. This may represent unrealised opportunities for stronger public health gains through nutrient-based tax designs in these countries.

NPMs translate nutrition science into regulatory thresholds across policies. In Chile, as part of an integrated regulatory approach, NPM supported taxation, warning labels, marketing restrictions, and school food standards, leading to reduced SSB purchases and greater consumer awareness [17]. Among the reviewed countries, Sri Lanka showed the most extensive application of NPMs across taxation, labelling, and marketing restrictions. However, this finding is based on a relatively small number of studies, and few sources assessed policy effectiveness. The NPM applications in Bangladesh, India, Nepal and Pakistan were fragmented. Although references to sugar reduction or healthy diets appeared in policy discourse, these were seldom harmonised across policy domains. Wider adoption of NPMs depends on country-specific capacity, including laboratory testing infrastructure, skilled regulators, and enforcement resources. However, differences in NPM adoption across countries are likely to reflect multiple factors beyond technical capacity. These include varying political priorities, trade and economic considerations, institutional fragmentation, industry influence, and differences in the national nutrition policy development. Given resource limitations, countries can begin with simpler nutrient thresholds, obligatory industry reporting, or targeted market monitoring as initial measures [47, 62]. These constraints may partly explain fragmented NPM uptake in South Asia.

We found weak consumer facing non-tax SSB regulatory measures in South Asia. FOP interpretive labelling in Chile, Mexico, and Peru, showed that warning labels and colour-coded systems improve consumer understanding and reduce purchases of high-sugar beverages [16, 17]. Lack of such systems outside Sri Lanka contrasts with these experiences, suggesting unrealised potential for consumer-facing interventions in South Asia. Nevertheless, the evidence base for Sri Lanka was limited, and few studies examined implementation fidelity. Recent reforms in Bangladesh show emerging regulatory momentum, with the “Safe Food (Advertisement and Claims) Regulations, 2025” banning misleading advertising, restricting exploitative child marketing, and regulating nutrition claims, creating a platform for future SSB-specific protections. Nepal also made labelling of packaged food items obligatory under the “Food Hygiene and Quality Act 2024”, which may support future nutrition-focused labelling reforms. Similarly, marketing restrictions to children were largely missing. Lack of digital and social media marketing regulation in South Asia represents a critical gap. Availability restrictions in schools and public institutions were mostly aspirational in policy recommendations rather than enforceable regulations. Since there were no assessments of compliance or effectiveness, many of these measures remain aspirational rather than fully operational in South Asia.

Research indicates that SSB taxes can be progressive in terms of health impact, despite being regressive financially, due to larger reductions in consumption among lower-income populations [63–65]. Although studies elsewhere showed that youth respond to labelling and marketing restrictions, there is no such evidence confirmed in the reviewed countries [66]. Additionally, there is a dearth of evidence on how these restrictions affect children’s consumption in these countries. The limited availability of policy evaluations examining the effects of SSB taxes on consumption represents an important evidence gap and may constrain evidence-informed policymaking in South Asia.

Aligned with global patterns, reports of SSB industry interference and political economy constraints in South Asia highlight the influence of industry opposition, lobbying, and legal challenges on tax policies [67–69]. These efforts have delayed implementation or diluted nutrient-based approaches, especially in Sri Lanka [26]. In Mexico, despite strong industry resistance to SSB taxes and FOPL, these reforms were implemented through political commitment, civil society advocacy and sustained health policy leadership [70–72]. Enhancing regulatory capacity and shielding public health policymaking from vested interests remain potential challenges in South Asia. Thus, they can leverage international lessons to better understand and manage industry influence as they promote SSB policies.

Our findings indicate that SSB taxation alone is insufficient and should be combined with non-tax measures to reduce consumption in South Asia. Similar comprehensive policies have also been recommended elsewhere [73]. Although the application of NPMs is limited in the region, developing and implementing harmonised nutrient criteria across taxation, labelling, marketing, and availability restrictions could enhance policy coherence and effectiveness in South Asia. Cross-country learning, particularly from Sri Lanka’s experience, may offer opportunities to inform policy development in other reviewed countries. We highlighted important evidence gaps across countries, populations, and policy domains. Across the reviewed countries, post-implementation evaluations of SSB policies were scarce, and enforcement effectiveness was limited, partly because several countries lacked SSB-specific policies. Future research should prioritise policy evaluation, including natural experiments, regulation compliance studies, and equity-focused analyses.

We followed established methods to ensure transparency and reproducibility of the review. Nevertheless, it had few limitations, such as excluding non-English national documents. Accordingly, some policy documents or government reports in local languages might remain excluded, especially in countries where official legislation and policy documents are published only in national languages. Despite supplementing database searches with grey literature, the comprehensiveness of the identified evidence could be limited by this language restriction. Similarly, the review focused on five South Asian countries and excluded others in the region. Although other countries were beyond the current review scope, future studies are warranted to examine SSB regulatory approaches and NPMs in these settings to provide a more comprehensive understanding of the regional policy landscape. Exhaustive search strategy included diverse literature for comprehensive policy mapping and regulatory analysis. Evidence varied across countries and policy components, with limited implementation fidelity and equity-focused analyses. However, double screening and cross-verification of data extraction strengthened consistency and facilitated cross-country comparisons.

Conclusion

In Bangladesh, India, Nepal, Pakistan, and Sri Lanka, SSB regulation is primarily tax-based, with limited use of broader nutrient-based profiling approaches and weak enforcement of complementary policies. Effectively addressing the rising consumption of SSBs may benefit from robust implementation of both tax and non-tax, nutrient-informed regulatory frameworks. Strengthening the evidence base and aligning policy intent with implementation are critical steps for SSB control and public health nutrition in South Asia.

Authors’ contributions

SMA, RH, RI, NA and GG conceptualised the study and led the overall design and manuscript development. SMA, TFC, PJ, MM, and SS contributed to study screening and selection. TFC, PJ, MM, and SS conducted data extraction, with cross-verification across teams. SMA, TFC, RS, and PJ led data synthesis and interpretation. SMA, TFC, GG, NA, and RS prepared the first draft. All authors contributed to the subsequent drafting, critical revising, and approval of the final manuscript. RH acted as the lead for funding acquisition for the study.

Funding

This research was funded by the “IDRC, Canada”, with the grant number as “110596-002”. The funders had no role in study design, data collection, data analysis, data interpretation, writing, or the decision to submit the manuscript.

Data availability

All data generated or analysed during this study are included in this published article and its supplementary files. Additional details can be made available from the project lead Rumana Huque (rumanah14@yahoo.com) upon reasonable request.

Declarations

Ethics approval and consent to participate

Not applicable.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.