Chile's drastic anti-obesity measures cut sugary drink sales by 23%

The world’s toughest controls over the promotion of sugary drinks, brought in by a nation beset by obesity, have cut purchases by nearly a quarter in two years, research has shown.

Instead of a sugar tax, which the UK and other countries have chosen to impose, Chile has banned sales in schools and adopted stark black and white labels aimed at warning and educating families about the health dangers of junk food and drinks for their children.

Unlike the UK’s traffic lights, which may award a red label for sugar but also green for fruit content, Chile’s ministry of health labels only deliver the bad news: high in sugar, high in salt or high in fat. Sugary drinks, unhealthy snacks and packaged foods must carry the front-of-pack labels.

Chile’s Law of Food Labelling and Advertising, which came into force in 2016, also restricts marketing to children of any such foods or drinks and bans them from sale in schools.

When the ban came in, the people of Chile were consuming more sugary drinks per head than any other country in the world, and counting the cost in terms of obesity, type 2 diabetes and other health problems.

Researchers from the University of North Carolina at Chapel Hill Gillings School of Global Public Health, publishing in the journal Plos Medicine, have found purchases of sugary drinks dropped by 23.7% during the first phase of the reforms. The largest changes were in the amount of sweetened fruit drinks and sweetened dairy drinks purchased.

“This regulation is different because it is the first to require warning labels about excess levels of nutrients of concern, such as sugar or sodium, on the front of food and beverage packages,” said first author Lindsey Smith Taillie, assistant professor of nutrition at the Gillings School.

“The regulation includes the world’s strictest limits on how and where food companies can advertise junk food to children. The reductions we observed in sugary drink purchases were markedly greater than those seen following the implementation of standalone policies – such as a tax on sugar-sweetened beverages – elsewhere in Latin America.”

The limits on acceptable levels of sugar, salt and fat have steadily dropped as tougher phases of the regulations were brought in. By the end of two years, the allowable amount of sugar in foods with no warning label will drop from 22.5g per 100g to 10g per 100g. Salt will halve from 800mg to 400mg per 100g.

“This impact in the first phase is pretty impressive,” said Barry Popkin, professor of nutrition at the Gillings School, who said it was having an effect on families’ understanding of what constitutes a healthy diet. “We did focus groups with low and middle-income mothers and they were saying their kids were coming home and telling them to buy stuff without warning labels.

“It is the first intervention we have seen showing potential for changing food norms. I think a lot of countries are going to look at this, because it is so impactful.”

Some already are. “What’s amazing about the Chilean regulations is how much they have already influenced international food policy,” said Taillie. “From our work with advocates and policymakers, we know that at least a dozen countries have directly used Chile’s policies and the evaluation results to develop and inform similar policies.

“We expect that in five to 10 years, much more of the world will look like Chile with regards to putting clearer labelling systems on food and drink packages to tell people which products are unhealthy and cut through the noise created by food marketing.”

Chile is classified as a high-income country by the World Bank, with sophisticated food systems in which retailers exert a lot of control over supply, very much like the UK and Europe. Popkin believes his team’s analysis of their food warning labels will show significant impact on buying habits – unlike the traffic-light labelling in the UK.

He thinks there will soon be evidence of positive effects on health but says the policies are aimed at long-term change, adding: “We will see a pretty immediate impact in the next few years on type 2 diabetes, but in overweight it takes time. We will get it in hypertension [high blood pressure] and diabetes but not quickly in weight.”

A separate study has shown that the sugary drinks levy in the UK appears to be a success, said researchers in Oxford, Cambridge and London, because many manufacturers had taken enough sugar out of their products to escape it.

The analysis, also published in the journal Plos Medicine, shows when George Osborne, the former chancellor, announced plans to introduce the tax, about 52% of eligible soft drinks contained 5g or more sugar per 100ml and were liable for the tax. The levy came into force in April 2018, and by February 2019, only 15% of soft drinks were still liable.

“The levy is an important policy as it both reduces the sugar level of many drinks and increases the prices of high sugar drinks, helping the public to make healthier choices. These population approaches are important not only for preventing disease but also for reducing health inequalities,’ said Dr Peter Scarborough, associate professor at the Nuffield Department of Population Health at the University of Oxford who led the analysis.