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Cited by 197Global Public Health Policies and EpidemiologyObesity, Physical Activity, DietEconomic and Fiscal Studies

Averting Obesity and Type 2 Diabetes in India through Sugar-Sweetened Beverage Taxation: An Economic-Epidemiologic Modeling Study

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Basu, Sanjay, Vellakkal, Sukumar, Agrawal, Sutapa, Stuckler, David, Popkin, Barry, Ebrahim, Shah·2014·PLoS Medicine
DOI 10.1371/journal.pmed.1001582PMC PMC3883641
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Abstract

BACKGROUND: Taxing sugar-sweetened beverages (SSBs) has been proposed in high-income countries to reduce obesity and type 2 diabetes. We sought to estimate the potential health effects of such a fiscal strategy in the middle-income country of India, where there is heterogeneity in SSB consumption, patterns of substitution between SSBs and other beverages after tax increases, and vast differences in chronic disease risk within the population. METHODS AND FINDINGS: Using consumption and price variations data from a nationally representative survey of 100,855 Indian households, we first calculated how changes in SSB price alter per capita consumption of SSBs and substitution with other beverages. We then incorporated SSB sales trends, body mass index (BMI), and diabetes incidence data stratified by age, sex, income, and urban/rural residence into a validated microsimulation of caloric consumption, glycemic load, overweight/obesity prevalence, and type 2 diabetes incidence among Indian subpopulations facing a 20% SSB excise tax. The 20% SSB tax was anticipated to reduce overweight and obesity prevalence by 3.0% (95% CI 1.6%-5.9%) and type 2 diabetes incidence by 1.6% (95% CI 1.2%-1.9%) among various Indian subpopulations over the period 2014-2023, if SSB consumption continued to increase linearly in accordance with secular trends. However, acceleration in SSB consumption trends consistent with industry marketing models would be expected to increase the impact efficacy of taxation, averting 4.2% of prevalent overweight/obesity (95% CI 2.5-10.0%) and 2.5% (95% CI 1.0-2.8%) of incident type 2 diabetes from 2014-2023. Given current consumption and BMI distributions, our results suggest the largest relative effect would be expected among young rural men, refuting our a priori hypothesis that urban populations would be isolated beneficiaries of SSB taxation. Key limitations of this estimation approach include the assumption that consumer expenditure behavior from prior years, captured in price elasticities, will reflect future behavior among consumers, and potential underreporting of consumption in dietary recall data used to inform our calculations. CONCLUSION: Sustained SSB taxation at a high tax rate could mitigate rising obesity and type 2 diabetes in India among both urban and rural subpopulations.

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  • Parental acceptance improved following education on the advantages of silver diamine fluoride, particularly when it served as an alternative to sedation or general anesthesia for children displaying significant anxiety or behavioral challenges.

    “An additional study demonstrated that parental acceptance improved following education on the advantages of silver diamine fluoride, particularly in cases where it served as an alternative to sedation or general anesthesia for children displaying significant anxiety or behavioral challenges [36].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [36]

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  • When parents were informed of silver diamine fluoride's ability to prevent further decay and reduce the need for more invasive treatments, 76% indicated a readiness to utilize SDF on posterior teeth.

    “However, when parents were informed of its ability to prevent further decay and reduce the need for more invasive treatments, 76% indicated a readiness to utilize SDF on posterior teeth [35,36].”

    From Minimally Invasive Techniques for Managing Dental Caries in Children: Efficacy, Applications, and Future Directions (2025) · cites this paper as [36]

    The Results (Tax Effects) and Discussion address sugar-sweetened beverage taxation, obesity, and diabetes in India, not dental treatment. Searches for silver diamine fluoride, posterior teeth, and the claimed 76% parental readiness found no passage addressing the claim in our copy. (LLM, conf=0.78)

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Cited by

Sorted by citations

Authors
Basu, S., Vellakkal, S., Agrawal, S., Stuckler, D., Popkin, B., & Ebrahim, S.
Affiliations
  • London School of Hygiene & Tropical Medicine (GB)
  • Public Health Foundation of India (IN)
  • University of North Carolina at Chapel Hill (US)
Corresponding author
Basu, Sanjay
ORCID
Venue
PLoS Medicine
Publisher
Public Library of Science (PLoS)
Published
2014-01-07
Volume
11
Issue
1
Pages
e1001582
ISSN
  • 1549-1277 (ISSN-L)
  • 1549-1676
DOI
10.1371/journal.pmed.1001582
PMC
PMC3883641
OpenAlex
W2009561990
Cited by
197
References
5
Citations by year
2026: 9 · 2025: 13 · 2024: 15 · 2023: 19 · 2022: 22 · 2021: 21 · 2020: 14 · 2019: 11 · 2018: 13 · 2017: 17 · 2016: 15 · 2015: 14 · 2014: 13 · 2013: 1
FWCI
43.25
Type
journal article
Language
en
Open access
Licence
Locations
  • PLoS Medicine (publishedVersion, cc-by)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • RePEc: Research Papers in Economics (submittedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
  • Figshare (submittedVersion, cc-by)
  • Greater South Information System
Funders
  • Wellcome Trust (084674, 313590)
  • National Institutes of Health (2r24hd050924-06)
  • National Institute on Aging (AG017253, P30AG017253)
  • Eunice Kennedy Shriver National Institute of Child Health and Human Development (R24 HD-050924)
Topics
  • Social Sciences › Business, Management and Accounting › Organizational Behavior and Human Resource Management › Global Public Health Policies and Epidemiology
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Obesity, Physical Activity, Diet
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Economic and Fiscal Studies
Keywords
excise tax, obesity prevention, type 2 diabetes incidence, beverage substitution, body mass index, glycemic load, microsimulation, India, urban-rural differences, middle-income countries
MeSH terms
Adult, Beverages, Diabetes Mellitus, Type 2, Female, Humans, India, Male, Middle Aged, Models, Theoretical, Obesity, Socioeconomic Factors, Sweetening Agents, Taxes, Incidence, Prevalence, Overweight

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