A key component of ‘obesogenic environments’ is the ready availability of convenient, calorie-dense foods, in the form of hyper-palatable and relatively inexpensive ultra-processed products. Compelling evidence indicates that the regular consumption of soft drinks, specifically carbonated and non-carbonated sugar-sweetened beverages (SSBs), has a significant impact on the prevalence of overweight and obesity. However, to implement country-level effective prevention programmes we need to supplement this evidence with quantitative knowledge of the relationships between overweight/obesity and the main determinants of SSB consumption, notably SSB prices and consumers’ disposable income. Affordability considers the simultaneous effects of both price and disposable income on the buying decision. The purpose of this study was to investigate the effect of SSB affordability on the consumers’ purchasing behaviour and weight-related health outcomes. Our study was divided into three parts. First, we computed SSB consumption and affordability for approximately 150 countries worldwide. Second, we estimated a demand function for SSBs to assess the impact of affordability on consumption at the country level. Third, we used a multivariate regression model and country data on the prevalence of overweight and obesity to test the role of SSB affordability in the current obesity epidemic. The analysis reveals that SSB affordability: 1) showed both a large variability across countries and a clear tendency to increase substantially with the level of economic development; 2) played a key role in determining cross-country differences in the amount of soft drink consumed per capita; and 3) was significantly associated with the prevalence rates of both overweight and obesity. Specifically, we show that a 10 % increase in SSB affordability was associated, on average, with approximately 0.4 more overweight/obese adults per 100 inhabitants. By controlling for the main possible confounding factors, our results clearly indicate that affordability is a major driver of purchasing behaviours and is significantly associated with the prevalence rates of both overweight and obesity. We thus suggest a fiscal approach to curb SSB consumption based on the effectiveness of ‘soda taxes’ to affect the long-term dynamic of SSB affordability.

中文翻译：

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加糖饮料的负担能力以及部分国家/地区超重和肥胖的患病率

“致肥胖环境”的一个关键组成部分是现成的方便，卡路里密集的食品，以高口味和相对便宜的超加工产品的形式提供。有力的证据表明，定期饮用软饮料，特别是碳酸和非碳酸糖加糖饮料（SSB），对超重和肥胖症的患病率有重大影响。但是，要实施国家一级的有效预防计划，我们需要对超重/肥胖与SSB消费的主要决定因素（尤其是SSB价格和消费者可支配收入）之间的关系进行定量了解，以补充这一证据。可承受性考虑了价格和可支配收入对购买决定的同时影响。这项研究的目的是调查SSB负担能力对消费者购买行为和与体重有关的健康结局的影响。我们的研究分为三个部分。首先，我们计算了全球约150个国家/地区的SSB消费量和可承受性。其次，我们估算了SSB的需求函数，以评估国家一级的可负担性对消费的影响。第三，我们使用了一个多变量回归模型和有关超重和肥胖患病率的国家/地区数据，以检验SSB负担能力在当前肥胖流行中的作用。分析表明，SSB的承受能力：1）既显示了各国之间的巨大差异，又显示出随着经济发展水平而显着增加的明显趋势；2）在确定人均软饮料消费量的跨国差异方面发挥了关键作用；3）与超重和肥胖的患病率显着相关。具体而言，我们表明，平均而言，每100名居民中，超重/肥胖成年人的单身汉负担能力提高10％。通过控制可能的主要混杂因素，我们的结果清楚地表明，负担能力是购买行为的主要驱动力，并且与超重和肥胖的患病率显着相关。因此，我们建议根据“苏打税”的有效性来控制SSB负担能力的长期动态，采取一种抑制SSB消费的财政方法。和3）与超重和肥胖的患病率显着相关。具体而言，我们表明，平均而言，每100名居民中，超重/肥胖成年人的单身汉负担能力提高10％。通过控制可能的主要混杂因素，我们的结果清楚地表明，负担能力是购买行为的主要驱动力，并且与超重和肥胖的患病率显着相关。因此，我们建议根据“苏打税”的有效性来控制SSB负担能力的长期动态，采取一种抑制SSB消费的财政方法。和3）与超重和肥胖的患病率显着相关。具体而言，我们表明，平均而言，每100名居民中，超重/肥胖成年人的单身汉负担能力提高10％。通过控制可能的主要混杂因素，我们的结果清楚地表明，负担能力是购买行为的主要驱动力，并且与超重和肥胖的患病率显着相关。因此，我们建议根据“苏打税”的有效性来控制SSB负担能力的长期动态，采取一种抑制SSB消费的财政方法。通过控制可能的主要混杂因素，我们的结果清楚地表明，负担能力是购买行为的主要驱动力，并且与超重和肥胖的患病率显着相关。因此，我们建议根据“苏打税”的有效性来控制SSB负担能力的长期动态，采取一种抑制SSB消费的财政方法。通过控制可能的主要混杂因素，我们的结果清楚地表明，负担能力是购买行为的主要驱动力，并且与超重和肥胖的患病率显着相关。因此，我们建议根据“苏打税”的有效性来控制SSB负担能力的长期动态，采取一种抑制SSB消费的财政方法。