US and UK Public Will Accept Moves to Reduce Soft Drink Sizes

May 12, 2015

PRAGUE — New research conducted in both the United Kingdom and the United States suggests that the public would accept "nudging" techniques to lower sugar-sweetened-beverage (SSB) intake to reduce obesity.

"Nudge" interventions involve modifying the environment — for example, limiting the size or changing the shape of drink containers or changing the location in which they are placed in stores.

There is good evidence that such actions reduce consumption, particularly among children, but the public acceptability of this type of intervention has not been examined previously, Dragos Petrescu, PhD, from the University of Cambridge, United Kingdom, told the 2015 European Congress on Obesity last week.

He and his colleagues sampled just over 1000 adults in the United Kingdom and a similar number in the United States; as well as asking about "nudging" techniques, participants were also questioned on the acceptability of more traditional interventions, such as increasing tax on SSBs or educational campaigns.

Taxation wasn't popular, with most of those polled finding it unacceptable. But the majority said "nudging" techniques were acceptable — which bodes well, said Dr Petrescu. "It's good news, as these interventions do have high potential."

The pattern of results was similar across the two countries, he noted.

Cochair of the session, Garrath Williams, PhD, from Lancaster University, United Kingdom, told Medscape Medical News: "I think it's very interesting that although the food industry often says that people are heavily opposed to measures that restrict their choice, or limit or nudge them, actually, consumers, when asked about this…are very much in favor of measures to improve diet quality."

Most People Found Nudging Acceptable, Even if Not Conscious

SSBs are a major contributor to obesity, and large portion sizes are known to increase consumption, with container shape also believed to play a role, Dr Petrescu said. And prominent placing of such products also increases the likelihood of purchase, he noted.

Modifying the environment in which people make choices — the "choice architecture" — has the potential to change behaviors in populations but has received criticism from ethicists. However, the public acceptability of such interventions has been unknown, he explained.

He and his colleagues set out to assess the acceptability of government in­terventions to reduce consumption of sugar-sweetened beverages: three nudge interventions (limiting portion size, changing container shape, and changing shelf location) and two traditional interventions (increased taxation and an education campaign) were explored.

They polled 1093 people recruited via a market research agency in the United Kingdom and 1082 from the Amazon Mechanical Turk in the United States.

Participants were divided into three groups — a control group, where they were informed containers would be smaller and changing the shape would mean people will drink less, but people will still be able to drink as much as they like.

In the second group they were additionally informed that people would be made aware of how these changes make them drink less (ie, it would be "conscious"), but that people will still be able to drink as much as they like. In the third group, people wouldn't be made aware ("unconscious") but again would be able to drink as much as they like.

Contrary to expectation, highlight­ing the unconscious mechanisms through which nudge interventions generally work "does not decrease their acceptability," Dr Petrescu observed.

Dr Williams agreed. It is encouraging "that interventions to alter portion size didn't come up as a concern among respondents, whether or not they are made aware of the detailed mechanism behind it," he commented.

Taxation Unpopular; Food Industry Exerts Pressure

For the majority of UK and US participants, the education campaign and the three nudge interventions were acceptable, with education attract­ing most support (86% in the United Kingdom and 90% in the United States).

The three nudge approaches were supported by the majority of participants, varying from just over 50% of respondents to almost 70%, depending on the exact intervention.

By contrast, just over 40% of participants supported taxation, which is "problematic because we know taxation works," Dr Petrescu observed.

He also explained that, when being asked about whether reducing container size of drinks was acceptable, people wanted to know whether this would affect the cost.

Support for Interventions to Reduce SSB Consumption

Intervention UK sample (%) US sample (%)
Education 85.8 89.8
Location 69.1 69.4
Size 59.9 53.5
Shape 52.4 58.5
Taxation 46.9 42.4

In conclusion, he said, "Nudge interventions to reduce consumption of sugary drinks appear to be acceptable to the public.

"Policymakers can be reassured about the public acceptability of nudging to reduce sugar-sweetened-beverage consumption; however, our results suggest taxation to lower consumption would not be popular with the majority of both the UK and US populations."

Fat Tax Abandoned in Denmark

A separate presentation from Denmark appears to bear this out. Sinne Smed, PhD, from the University of Copenhagen, told the ECO meeting how a "fat" tax introduced there in 2011 failed to catch on — it was withdrawn within 2 years, due to austerity and pressure from the food industry, despite the fact that it could have saved lives.

She and her team determined the impact of the tax on consumption of saturated fat and other nontargeted dietary measures and then estimated the effect of these changes on mortality due to noncommunicable diseases. They estimated that the fat tax resulted in 118 fewer deaths, around half of which were in people aged under 75 years, a decrease of 0.3%.

"Despite clear evidence of positive health effects…the Danish fat tax was abolished in late 2012. The removal of the tax was largely a political decision and also due to the focus of the public being shifted toward the economic crisis," she explained.

"The food industry also argued strongly against the tax, which was reported widely in the media and gave the tax a bad reputation and turned public opinion against it."

2015 European Congress on Obesity. May 9, 2015. Abstracts T3:RS1.3, T6:RS1.1.

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