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Associations between trajectories of obesity prevalence in English primary school children and the UK soft drinks industry levy: An interrupted time series analysis of surveillance data

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  • Nina T Rogers
  • Steven Cummins
  • Hannah Forde
  • Catrin P Jones
  • Oliver Mytton
  • Harry Rutter
  • Stephen J Sharp
  • Dolly Theis
  • Martin White
  • Jean Adams

Abstract

Background: Sugar-sweetened beverages (SSBs) are the primary source of dietary added sugars in children, with high consumption commonly observed in more deprived areas where obesity prevalence is also highest. Associations between SSB consumption and obesity in children have been widely reported. In March 2016, a two-tier soft drinks industry levy (SDIL) on drinks manufacturers to encourage reformulation of SSBs in the United Kingdom was announced and then implemented in April 2018. We examined trajectories in the prevalence of obesity at ages 4 to 5 years and 10 to 11 years, 19 months after the implementation of SDIL, overall and by sex and deprivation. Methods and findings: Data were from the National Child Measurement Programme and included annual repeat cross-sectional measurement of over 1 million children in reception (4 to 5 years old) and year 6 (10 to 11 years old) in state-maintained English primary schools. Interrupted time series (ITS) analysis of monthly obesity prevalence data from September 2013 to November 2019 was used to estimate absolute and relative changes in obesity prevalence compared to a counterfactual (adjusted for temporal variations in obesity prevalence) estimated from the trend prior to SDIL announcement. Differences between observed and counterfactual estimates were examined in November 2019 by age (reception or year 6) and additionally by sex and deprivation quintile. In year 6 girls, there was an overall absolute reduction in obesity prevalence (defined as >95th centile on the UK90 growth charts) of 1.6 percentage points (PPs) (95% confidence interval (CI): 1.1, 2.1), with greatest reductions in the two most deprived quintiles (e.g., there was an absolute reduction of 2.4 PP (95% CI: 1.6, 3.2) in prevalence of obesity in the most deprived quintile). In year 6 boys, there was no change in obesity prevalence, except in the least deprived quintile where there was a 1.6-PP (95% CI: 0.7, 2.5) absolute increase. In reception children, relative to the counterfactual, there were no overall changes in obesity prevalence in boys (0.5 PP (95% CI: 1.0, −0.1)) or girls (0.2 PP (95% CI: 0.8, −0.3)). This study is limited by use of index of multiple deprivation of the school attended to assess individual socioeconomic disadvantage. ITS analyses are vulnerable to unidentified cointerventions and time-varying confounding, neither of which we can rule out. Conclusions: Our results suggest that the SDIL was associated with decreased prevalence of obesity in year 6 girls, with the greatest differences in those living in the most deprived areas. Additional strategies beyond SSB taxation will be needed to reduce obesity prevalence overall, and particularly in older boys and younger children. Trial registration: ISRCTN18042742. Nina T Rogers and colleagues investigate changes in the levels of obesity in children aged 4-5 years and 10-11 years, 19 months after the implementation of UK soft drinks industry levy.Why was this study done?: What did the researchers do and find?: What do these findings mean?:

Suggested Citation

  • Nina T Rogers & Steven Cummins & Hannah Forde & Catrin P Jones & Oliver Mytton & Harry Rutter & Stephen J Sharp & Dolly Theis & Martin White & Jean Adams, 2023. "Associations between trajectories of obesity prevalence in English primary school children and the UK soft drinks industry levy: An interrupted time series analysis of surveillance data," PLOS Medicine, Public Library of Science, vol. 20(1), pages 1-18, January.
    • Handle: RePEc:plo:pmed00:1004160
    DOI: 10.1371/journal.pmed.1004160
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    References listed on IDEAS

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    1. Fletcher, Jason M. & Frisvold, David E. & Tefft, Nathan, 2010. "The effects of soft drink taxes on child and adolescent consumption and weight outcomes," Journal of Public Economics, Elsevier, vol. 94(11-12), pages 967-974, December.
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    3. Fichera, Eleonora & Mora, Toni & Lopez-Valcarcel, Beatriz G. & Roche, David, 2021. "How do consumers respond to “sin taxes”? New evidence from a tax on sugary drinks," Social Science & Medicine, Elsevier, vol. 274(C).
    4. Rachel Griffith & Martin O'Connell & Kate Smith & Rebekah Stroud, 2020. "What's on the Menu? Policies to Reduce Young People's Sugar Consumption," Fiscal Studies, John Wiley & Sons, vol. 41(1), pages 165-197, March.
    5. Ryota Nakamura & Andrew J Mirelman & Cristóbal Cuadrado & Nicolas Silva-Illanes & Jocelyn Dunstan & Marc Suhrcke, 2018. "Evaluating the 2014 sugar-sweetened beverage tax in Chile: An observational study in urban areas," PLOS Medicine, Public Library of Science, vol. 15(7), pages 1-22, July.
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    1. Madison Luick & Lauren K Bandy & Richard Harrington & Jayalakshmi Vijayan & Jean Adams & Steven Cummins & Mike Rayner & Nina Rogers & Harry Rutter & Richard Smith & Martin White & Peter Scarborough, 2024. "The impact of the UK soft drink industry levy on the soft drink marketplace, 2017–2020: An interrupted time series analysis with comparator series," PLOS ONE, Public Library of Science, vol. 19(6), pages 1-16, June.
    2. Karl M F Emmert-Fees & Ben Amies-Cull & Nina Wawro & Jakob Linseisen & Matthias Staudigel & Annette Peters & Linda J Cobiac & Martin O’Flaherty & Peter Scarborough & Chris Kypridemos & Michael Laxy, 2023. "Projected health and economic impacts of sugar-sweetened beverage taxation in Germany: A cross-validation modelling study," PLOS Medicine, Public Library of Science, vol. 20(11), pages 1-25, November.

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